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C53. Skip the Dealer: Mobile injectable opioid agonist therapy as a response to the Covid 19 pandemic

C53. Skip the Dealer: Mobile injectable opioid agonist therapy as a response to the Covid 19 pandemic

Learner category:

  • Beginning Level
  • Novice Level
  • Intermediate Level

Learning objectives:

  • Participants will learn how a mobile iOAT team was developed and which clients were most suitable for this service
  • Participants will identify the benefits and challenges of a mobile approach for iOAT

Abstract

Injectable opioid agonist therapy (iOAT) is an evidence based treatment for patients with severe opioid use disorder. This requires attendance at a clinic up to three times per day. COVID-19 arrived in Alberta and the iOAT program planned how to continue treatment. The clinic would remain operational during the pandemic, however steps were taken to reduce the volume of patients in the clinic. iOAT clients are particularly vulnerable due to a convergence of risk factors, including physical comorbidities, poverty, and the ongoing risk from a toxic drug supply. A mobile team was assembled to provide iOAT services in patient homes. Patients were prioritized based on: co-morbidities, housing at isolation hotels, geographic location, and willingness to self-isolate. The mobile opioid agonist therapy (MOAT) team was created to bring iOAT and its wraparound care to patients. MOAT included an outreach worker, mental health clinician, registered nurses, and pharmacists, along with nurse practitioner and physician support. Half of Calgary iOAT patients moved to the MOAT team. Nursing care and psychosocial supports were provided beyond medication administration. Patients’ self-report of this service were very positive. Engagement in treatment was enhanced by this intervention. There were no COVID-19 infections in patients or the staff. The pandemic necessitated the creation of MOAT, but in doing so, a model of care was developed that could serve well beyond it. The opioid crisis continues alongside COVID-19 and MOAT is a viable, creative, client-centered approach that addresses a dual public health crisis to protect society’s most vulnerable individuals.

Authors

Cristina Zaganelli
MN NP Alberta Health Services

Cristina is a nurse practitioner with a practice focus in primary care, substance use, mental health, and homelessness. She graduated from the University of Calgary and Dalhousie University. Cristina works at the Injectable Opioid Agonist Therapy Clinic, Youth Substance Use and Mental Health Services, and The CUPS Health Clinic.

Stacey Whitman
MN RN Alberta Health Services

Stacey Whitman is the Manager Calgary Injectable Opioid Agonist Treatment Program and the Calgary Opioid Dependency Program (ODP). She is a registered nurse and competed her Master of Nursing Degree in 2017. Stacey has worked in a variety of settings including acute care, outpatient programming and residential care.

Comments (6)

  1. Dennis Hagarty

    Nicely done. Innovative way to serve clients. Why was hydromorphone used rather than other agonist or antagonists?

    1. Cristina Zaganelli

      Hydromorphone is the primary medication used at our iOAT (injectable opioid agonist therapy) program. It is used as the short-acting agent to keep clients out of withdrawal and provide a quick-onset of action. Clients also receive a long acting, traditional opioid agonist medication, either methadone or Kadian (SROM), that covers their withdrawal overnight. We even have some clients micro-dosed on to buprenorphine/naloxone.

  2. Joycelyn Iheanacho

    Thank you for sharing this innovative approach to addressing OUD in the middle of a pandemic. Inspirational!

  3. Rita Hanuschock

    Impressive !!! i compliment your team and the AHS for making this possible and acceptable.
    It seems the program helps reduce the stigma associated with addiction.
    How is the medication and supplies financed?

  4. Tae Joon (TJ) Park

    That was impressive. I am just curious if there were any safety concerns since you are carrying all drugs with you in the car. I used to work as a home health nurse, and I had to be very cautious about where I drove and parked my car. Thanks! TJ

  5. Rachel Shuster, BSN, RN, CARN, CAAP

    Thank you so much for your presentation. I especially appreciated your comments on the challenges from and effects of COVID-19 on your overall operations/etc. Additionally, Greg’s story is simply beautiful! Thank you for including that and for your presentation!

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