Alcohol Use Disorder (AUD) in the COVID-19 Context
Now more than ever it is important for your patients to look after their health and receive care from you as their healthcare provider. It’s essential that patients continue to seek out care that they need.
This tool has been developed to support primary care providers in navigating and providing patient care in a world where COVID-19 is the ‘new normal’, with considerations and recommendations on what’s ‘new’ and what’s ‘changed’ in the delivery of care for patients living with AUD. While how care is delivered has changed, efforts should be made to ensure that the quality has not. As always, when treating your patients, continue to use your clinical judgement and follow standards of care, best practices, evidence and guidelines.
Patients with alcohol use disorder (AUD) are at increased risk for negative health outcomes during the COVID-19 pandemic. Therefore, patients with or at risk for developing AUD must be proactively identified and followed to ensure continuity of care.
Click on the sections below to get started:
What’s new, what’s changed
- Impaired immune function and reduced cognitive functioning associated with AUD can put patients at risk for contracting the virus.
- Disruptions in alcohol supply, leading to alcohol withdrawal, can have potentially life-threatening consequences.
Putting it into practice
For patients with already-scheduled AUD follow-up appointments
Host appointment remotely if possible and maintain the existing management plan.
For patients with already scheduled non-AUD appointments
Where feasible, review history for past or present AUD before the appointment. If positive, follow the steps outlined under Management below.
For patients without appointments
Where feasible, proactively seek to identify those with past or present AUD (e.g. through EMR searches) and follow-up to book a remote appointment following the steps under Management below.
Where possible, use remote/virtual care approaches when conducting regular assessments in order to maintain social distancing while supporting patient and reducing overall risk (BC Centre on Substance Abuse, April 9, 2020).
Putting it into practice
- Inquire into how the patient is doing. Provide non-judgmental and supportive care approaches.
- Consider providing patients with or at risk of developing AUD with the following infographic: Alcohol and the Immune System – 4 things you should know (CCSA, 2020)
- Discourage the abrupt discontinuation of alcohol use, while also using the COVID-19 pandemic as an opportunity to motivate patients who drink to consider reducing alcohol consumption. Inform patients that high level alcohol use may suppress various organ systems, including the immune system, increasing vulnerability to COVID-19 infection (BC Centre on Substance Abuse, April 9, 2020).
- If you are newly prescribing pharmacotherapy for a patient with AUD, see the Alcohol Use Disorder Tool (CEP, 2019) for steps.
- For patients at risk of going into withdrawal or those planning to go into withdrawal, take a history remotely to determine (META:PHI, April 3, 2020):
- Recent drinking pattern (number of drinks per day and number of drinking days per week in the past month)
- Time of last drink
- Daily withdrawal tremors quickly relieved by alcohol
- History of emergency department visits for withdrawal symptoms
- History of withdrawal related seizures
- Concurrent use of other substances
- Concurrent health conditions
- Current medications
Putting it into practice
Does patient report drinking daily and experiencing regular withdrawal symptoms?
Patient will likely require medical management.
- If the patient HAS a history of severe withdrawal symptoms and seizures and/or complicating medical conditions (e.g., liver failure, COPD, advanced age, or on high doses of opioids) they will likely require withdrawal management in the emergency department.
- If the patient DOES NOT HAVE a history of severe withdrawal symptoms, seizures and/or complicating medical conditions, the patient may be a good candidate for a day detox procedure at a local RAAM clinic. Contact the patient’s local RAAM clinic to check if they are accepting patients for on-site detox during COVID-19. If a local RAAM clinic is unable to offer on-site detox, ask if the RAAM clinic physician can provide you/your patient with support implementing a home detox (META:PHI, April 3, 2020). Alternatively seek support via OTN eConsult.
Patient likely DOES NOT need medication for withdrawal management.
- Continue to prescribe naltrexone oral and acamprosate (if indicated) (CEP, 2019), arrange regular follow-up remote appointments and direct to online non-pharmacological options (Canadian Society of Addiction Medicine, 2020).
- North: North West, North East
- West: Erie St. Clair, South West, Waterloo Wellington, Hamilton Niagara Haldimand Brant
- Central: Central West, Central, Mississauga Halton, North Simcoe Muskoka
- East: Central East, South East, Champlain
- Toronto: Toronto Central
- Online Resources of support for People with Substance Use Disorders (CSAM, March 22, 2020).
- ConnexOntario – Addiction, Mental Health, and Problem Gambling Treatment Services.
- Local Services Resource (CEP, 2020).Up-to-date availability on a number of priority services including pharmacies, laboratories, mental health services, homecare and more.
These supporting materials and resources are hosted by external organizations. The accuracy and accessibility of their links are not guaranteed. CEP will make every effort to keep these links up to date.
Acknowledgement and legal
The COVID-19 Resource Centre was developed by the Centre for Effective Practice (CEP) in collaboration with the Department of Family Medicine at McMaster University, the Ontario College of Family Physicians and the Nurse Practitioners’ Association of Ontario using a rapidly modified version of the CEP’s integrated knowledge translation approach. They are some of several clinical resources developed as part of the Knowledge Translation in Primary Care Initiative. Funded by the Ministry of Health and Long-Term Care, this initiative supports primary care providers with the development of a series of clinical tools and health information resources. Learn more about the Knowledge Translation in Primary Care Initiative.
Clinical Working Group
A clinical working group was established and provides significant input and oversight into the development of this resource. Members include:
• Claudia Mariano, MSc, NP-PHC
• Darren Larsen, MD, CCFP, MPLc
• Derelie Mangin, MBChB (Otago), DPH (Otago), FRNZCGP (NZ)
• Dominik Nowak, MD MHSc, CCFP, CH
• Jennifer P. Young, MD, FCFP-EM
• Lee Donohue MD, CCFP, MHSc, MPLc
• Mira Backo-Shannon, MD, BSc, MHSc
• Paul Preston, MD, CCFP, CCPE, CHE
• Rob Annis, MD, CCFP
• Soreya Dhanji, MD, CCFP
In addition to our clinical working group the CEP also obtained feedback from others, including:
• Arun Radhakrishnan, MSC, MD, CM, CCFP
• Central Region Primary Care Leadership
• David Daien, MD, CCFP
• David Makary, MD, CCFP
• David Price, BSC, MD, CCFP, FCFP
• Jose Silveira, BSC, MD, FRCPC, DIP, ABAM
• Michael Chang MD, FRCP(C)
• Payal Agarwal, MD, CCFP
• Robert Sauls MD, CCFP(PC), FCFP
• Tara Walton, MPH
Lastly, for certain sections, the CEP also obtained feedback from others, specifically:
Readiness assessment for delivering in-person care
Operational requirements for in-person care
COVID-19 Provincial Primary Care Advisory Table
• David Price (Chair), MD
• Andrea Sereda, MD
• Annelind Wakegijig, MD
• Beth Sweeney
• Cathy Faulds, MD
• David Daien, MD
• David Kaplan, MD
• Kamila Premji, MD
• Kelly Van Camp
• Kim McIntosh, MD
• Michael Green, MD
• Rebecca Carson
• Sarah Newbery, MD
• Thuy-Nga (Tia) Pham, MD
• Registered Nurses Association of Ontario
• Association of Family Health Teams of Ontario
Thank you to everyone who supported the development of this resource.
In collaboration with:
With support from: