Alcohol Use Disorder (AUD) in the COVID-19 Context

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The Alcohol Use Disorder (AUD) in the COVID-19 Context resource is revised often and new content is added regularly to guarantee that the latest evidence and regulatory recommendations are included. The CEP is committed to ensuring this information is accurate and up to date.
Last reviewed: November 16, 2020
Last updated: October 21, 2020

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.

Seek support: The following information is for primary care providers who are proficient in AUD management. If you need support providing the best care possible for your patients, consult specialists via OTN eConsult or by contacting the physicians at your local RAAM clinic.

Key takeaway

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

Jump to:

Screening

  • 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.

Management

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

Treatment

Putting it into practice

Does patient report drinking daily and experiencing regular withdrawal symptoms?

Yes

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.

No

Patient likely DOES NOT need medication for withdrawal management.

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