Friday, April 24, 2020

Isolation Puts Seniors With Substance Use Disorders at Heightened Risk During COVID-19

The social distancing and stay-at-home orders of the COVID-19 pandemic may present a challenge for people with substance use disorders by triggering anxiety, depression, or the urge to take drugs or drink alcohol. For people ages 65 or older, a population already vulnerable to the mental health effects of isolation, sequestering may be disproportionately burdensome.

“As long as social distancing guidelines remain in place, older adults in recovery from substance use disorders may find themselves cut off from support if they are unable to effectively use online treatment and self-help resources,” wrote Derek D. Satre, Ph.D., of the University of California, San Francisco, and Kaiser Permanente and colleagues in an article in the American Journal of Geriatric Psychiatry.

In the article, Satre and colleagues outlined key areas of concern for mental health professionals who work with seniors and offer guidance on how to help older patients.

Alcohol. Alcohol use can impair the immune system and increase susceptibility to pneumonia and other infectious diseases. Minimizing alcohol consumption may be critical for seniors during the pandemic, the authors wrote. They encourage mental health professionals to ask about their senior patients’ drinking habits and any recent increases in drinking that may stem from causes such as social isolation, financial stressors, anxiety, depression, or thoughts of suicide. The authors noted that pharmacologic treatments for alcohol use disorders such as naltrexone and brief behavioral interventions such as motivational interviewing can be incorporated into care, including care provided through telemedicine.

Tobacco and cannabis. Satre and colleagues noted evidence that smoking tobacco raises the risk of more severe COVID-19–related symptoms and that vaping nicotine “may damage lungs in ways that make users especially vulnerable to COVID-19–related symptoms.” They wrote that patients should be encouraged to use nicotine replacement products such as patches or gum or take anti-craving medications such as bupropion. They added that patients who use cannabis should use edible forms rather than smoke or vape.

Prescription opioids and benzodiazepines. Social distancing and quarantine may interrupt care for people with opioid use disorder and decrease their access to medication treatment, they wrote. “Lack of treatment access, in combination with social isolation, increases vulnerability to relapse and overdose for older adults during the pandemic.”

Satre and colleagues noted that although there are no published data regarding changes in benzodiazepine prescription rates associated with the pandemic, previous research has shown increased use associated with “disaster situations.” They added that the American Geriatrics Society Beers Criteria strongly recommends avoiding benzodiazepine use in seniors except in specific circumstances such as alcohol withdrawal because of the risk of cognitive impairment, falls, fractures, delirium, and other serious adverse events.

“Risks to older adults can be addressed by helping to expand access to interventions and by incorporating the assistance of partners, family, and caregivers in helping older patients use healthier coping techniques to manage stress as the pandemic continues,” they concluded.

For related information, see the Psychiatric News article “SAMHSA Issues Guidance on OUD Treatment During COVID-19.”

(Image: iStock/Cecilie_Arcurs)

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APA’s free, live virtual Spring Highlights Meeting is just days away. Join psychiatry’s foremost experts and leaders this Saturday and Sunday, April 25 and 26, for discussions about physician leadership in a time of crisis, challenges and opportunities in research, and more. Participants in the free Spring Highlights Meeting can claim up to 10 AMA PRA Category 1 Credits and 8 hours of MOC Part 2 Credit but must register to claim credit.


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