Medically Monitored Detox Complicated by COVID-19, a Narrative Review of the Literature

Alesia Cloutier, DO, MS

VA Boston Healthcare System
Medically Monitored Detox Complicated by COVID-19, a Narrative Review of the Literature

Scientific Abstract

Background: The COVID-19 pandemic represents an unprecedented time that has had a particularly devastating effect on patients with substance use disorder. The literature has shown an increase in substance use and an increase in complicated withdrawal within this population. They are also often a marginalized population whose engagement in risky behaviors, lack of stable housing, and medical comorbidities puts them at increased risk of contracting SARS-CoV2. Here we present a narrative review of the literature with relevant clinical vignettes that highlight the complexity and relevant safety consideration of treating medically monitored detox complicated by COVID-19 infection.

Methods: PubMed and Google scholar were searched using a boolean combination of the following key terms, “COVID-19,” “addiction,” “detox,” “alcohol,” “substance use,” “opioids,” “SARS-CoV2,” and “stimulants.” Relevant articles published from January 2020 to February 2021 were reviewed for inclusion. A narrative review format was deemed appropriate, given the scarcity of literature available on the topic.

Results: Here we present patient vignettes highlighting the considerations relevant to clinicians who are treating patients during detox complicated by concurrent SARS-CoV2 infection. The impact COVID-19 has on multiple organ systems, and the increased risk of complications that can arise secondary to these changes during detox is discussed. The potential psychotropic safety concerns in patients that are actively detoxing during a COVID-19 infection and the safety concerns of medication assisted therapies for addiction, as well as suggested considerations for treatment options given these concerns will also be elaborated upon.

Conclusion: To our knowledge this is the first narrative review discussing the unique challenge faced by consultation-liaison psychiatrists who are responsible for treating patients for substance detox complicated by an active COVID-19 infection. More research studies are needed to fully elucidate the appropriate treatment recommendations for these patients.

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Alesia Cloutier, DO, Jennifer McMahon, MD, Justine Lazatin, DO, Grace Chang, MD

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