Patients requiring daily opioids for chronic pain are more vulnerable to getting infected with CoronaVirus due to the effects opioid analgesics have on the pulmonary system. Opiates increase the risk of respiratory depression, negatively impact the immune system, and fever may increase the absorption of certain opioid patches.
Increased Risk of Respiratory Depression
A common complication of opioid use is respiratory system depression, which is especially important while prescribing opioids during the pandemic. There are direct effects on the pulmonary system, including granulomatous changes leading to bronchoconstriction, as there are opioid receptors located in the bronchial walls. Potential indirect complications of opioids are that they can decrease the respiratory centers' activity in the central nervous system by reducing the sensitivity of the peripheral chemoreceptors to carbon dioxide. The brainstem regulates respiration, and hypoxic and hypercapnic responses can be affected by opioids.
Negative Impact on the Immune System
Another vital and potentially grave complication when prescribing opioids for patients is the negative impact on their immune system, which places COVID-19 them at risk for infection transmission. Opioids can increase histamine release, which leads to bronchospasm and vaso-constriction, which is exacerbated while prescribing opioids during the pandemic.
Patients with chronic conditions, such as Rheumatoid Arthritis, Lupus, and cancer undergoing treatment, are already immunocompromised, and precautions must be taken in this group of patients during this pandemic.
Extra Caution Necessary for Patients on a Transdermal Opioid Patch
Patients on transdermal fentanyl or transdermal buprenorphine patches need to take additional precautions as fever, a common symptom of the virus, can increase the absorption of the opioid analgesic. These patients are at high risk of opioid-induced respiratory depression. While prescribing opioids during the pandemic, it is especially important for patients to have a supply of naloxone available.
Elective Procedures Canceled Secondary to COVID-19
Procedures to decrease pain such as epidural injections, nerve blocks, trigger point injections, etc. may be considered non-emergent, thus requiring scheduling delay. During these times, patients must have access to communicate with their health care providers and receive proper guidance.
Taking Extra Precaution with Smokers
In general, COVID-19 puts patients on opioids at higher risk, in particular in populations who are already immunocompromised, smokers, have sleep apnea, and chronic pulmonary diseases. Smoking cigarettes, marijuana, and vaping predispose the lungs to be more susceptible to infection when prescribing opioids during the pandemic.
Benzodiazepines and Opioid Analgesics
Patients consuming both opioids and benzodiazepines are more prone to respiratory depression. The coronavirus that causes COVID-19 is more likely to present with significant symptoms in those patients with a compromised respiratory system. Scriptulate identifies patients who are taking both benzodiazepines and opioids, alerting the provider to address this issue, which will lead to a better income. We provide the tools for the prescriber, leaving less room for error, more while documenting the prescriber’s due diligence.
Additional Documentation and Increased Administrative Burdens
Scriptulate makes prescribing opioids during the pandemic safe. It is vital to ensure patients are getting the best treatment possible. We will remove the provider's administrative burdens in order to allow the provider to focus on the patient. Our platform allows the provider to set an alert to identify and treat patients who are infected with COVID-19.
We are always interested in how the current events and environment can oftentimes alter the way we practice medicine. It’s interesting, yet challenging to make sure that we all pay attention to what is going on in the patient's room even before he or she walks in. We should have an idea of what they are going through, what kind of environment they may be in, and how that may shape their current physical and mental status.
Telehealth has become a norm and is here to stay for the vulnerable patients. We look forward to discussing how we will need to spend extra time documenting, as now we cannot examine the patient, take a look at his or her behavior, and have to make subjective decisions when it comes to prescribing controlled substances.