Quarantine, work from home, and economic instability during the coronavirus outbreak have caused an increase in alcohol and drug use in some countries. The current approaches to the treatment of substance abuse are not viable anymore, many scientists think. This hallmark report, with contributions from Sechenov University, provides a guideline for medical workers to improve the situation.

The outbreak of SARS-CoV-2, declared a pandemic on 11 March 2020 by the World Health Organisation (WHO), is one of the most challenging medical problems of the last decades. Nations across the globe have implemented social distancing, quarantine measures, re-organisation of their healthcare systems, and instituted emergency economic manoeuvres. Only now are we starting to realise how deeply the pandemic has affected people in ways that we could not easily have foreseen. For example, individuals who abuse legal and illegal substances are at higher risk of contracting the SARS-CoV-2 infection and dying of COVID-19 than the general population. An international group of scientists analysed this problem and presented their findings in BMC Medicine.

For many people, the COVID-19 situation and the associated economic recession are resulting in isolation, unemployment, and emotional distress — factors which traditionally worsen the abuse of alcohol and other drugs. The substance use disorders (SUDs) have multiple implications, and the clinical approaches rapidly implemented in some countries during the pandemic need to remain in place afterwards, according to the authors of the study. They point out that the SUD treatment protocols used today are largely based on those last updated during the heroin pandemic four decades ago, and it is time to move forward.

Among the steps that can be taken to improve the treatment of addiction, the authors name the following seven measures: (1) telemedicine and digital solutions; (2) ‘hospitalisation’ at home; (3) consultation-liaison between psychiatric and addiction services; (4) harm-reduction facilities; (5) person-centred care; (6) promotion of paid work to improve the quality of life for the people with SUDs; (7) integrated addiction care. The authors also highlight the need to adhere to the WHO’s policy to reduce availability, increase prices, and ban the advertising of harmful drugs.

Telemedicine appears to be a very useful instrument for the reduction of alcohol use and management of depression. The use of this technology for SUDs is not limited to online appointments — smartphone interventions, text messaging for continuing contact and care, and wearable devices all create treatment options to help healthcare professionals and patients in making treatment decisions.

Another important aspect of SUD management is outpatient therapy, including home hospitalisation. This approach has already proven to be successful in the treatment of mental illness worldwide, and its potential for SUD treatment is enormous. Hospitalisation at home results in fewer admissions to hospital and greater patient satisfaction.

Finally, it is crucial to implement the ‘housing first’ practice for homeless persons with co-occurring mental illness and SUDs. This strategy focuses on providing a stable home environment without requiring abstinence prior to or during treatment.

‘During the coronavirus pandemic, we have learnt a lot about how to improve the prevention measures and interventions for substance use disorders, which we can and should keep in the post-pandemic world’, said Prof Jürgen Rehm, a member of the Department of International Health Projects at Sechenov University and one of the authors of the paper. ‘A more efficient use of technological advances such as telemedicine is one of the key steps for the future. Another strategy is to create improved integrated treatment systems that should include primary healthcare and services at home’.

The pandemic gives an opportunity to modernise SUD treatment, and it is necessary to avoid the temptation to employ the strategies which may seem readily available but yield poor results. Reduction of the stigma associated with substance abuse is a critical step for society and is required to improve the health outcomes and future of millions of people.

The study contains contributions by a large international group of researchers. Russia is represented by Sechenov University (Department of International Health Projects, Institute for Leadership and Health Management), and other participants come from Spain, France, Italy, Belgium, Germany, UK, US, and Canada.

Read more: López-Pelayo H, Aubin H, Drummond C et al. “The post-COVID era”: challenges in the treatment of substance use disorder (SUD) after the pandemic. BMC Med (2020).

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