Is it safe to use opioids to manage my chronic pain through the COVID19 pandemic?

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The use of high doses of opioids may pose a higher risk for more severe disease severity with COVID-19 due to associated side effects such as the potential for decreased immune responses, sleep-disordered breathing, ventilatory impairment in post-operative and obese groups, and some indications of pathophysiological causes for the increased risk of pneumonia. 

If you are taking opioids regularly for pain and develop symptomatic COVID-19, your clinical team may consider a careful opioid dose reduction (but not full withdrawal) because of the potential for heightened sensitivity to adverse effects, including the potential for respiratory function depression.

However it is important to note that the link between COVID-19 and opioid use is purely speculative, given a lack of any published data looking specifically at associations between COVID-19 and opioid use.

It is also important to note that rapid opioid dose reduction also poses risks including more severe pain and neuro-psychological effects so you should not make any changes to your usual medication and should follow careful consideration of dosage only in consultation with a prescribing practitioner.

You can also access Naloxone, a drug that can temporarily reverse the effects of an opioid overdose or adverse reaction, as a precautionary measure. Naloxone is currently available free and without a prescription in participating pharmacies throughout New South Wales, South Australia and Western Australia under the Federal Government’s Take Home Naloxone Pilot program. Naloxone is easy to use and available as a Nasal spray, Pre-filled syringe or Ampoules under the Pilot program. Family or household members of anyone using opioids can also freely access Naloxone under this program.

I cannot access my usual pain management team right now. What can I do to manage my chronic pain?

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Due to the COVID-19 pandemic, many clinics and health professionals are limiting face to face consultations to minimise the risk of infection.

The Federal Government has announced a major expansion of telehealth services that has ensured ongoing access to care during these times of social distancing. From 13 March 2020 to 30 September 2020 (inclusive), new temporary MBS telehealth items have been made available to help reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers.

The new temporary MBS telehealth items are available to GPs, medical practitioners, nurse practitioners, participating midwives and allied health providers. The bulk billing incentive Medicare fees have temporarily doubled (until 30 September) for items relating to General Practice, Diagnostic Imaging and Pathology services. These items can be claimed with the telehealth items where appropriate.

Telehealth access will reduce healthcare workers’ and patients’ exposure to infection and enable you to continue to access your multidisciplinary pain management team. You should contact your current provider to see if you can access services through telehealth.

GPs and other medical practitioners must bulk-bill the COVID-19 telehealth and telephone consultation services where the service is provided to a concessional or vulnerable patient or a child under 16.

Face to face consultations are also still available in many practices, so speak to your health practitioner to learn more on how they can best support you.

Prescribing 

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Interim arrangements are now in place for prescribing to make supply of medicine more convenient following a telehealth consultation.  

Under the interim arrangements, a digital image (such as a photo, scan or pdf) of a prescription can be sent electronically by the prescriber to your pharmacy of choice. This electronic copy can be used by the pharmacy to supply the medicine and claim from the PBS in the same way as a paper prescription. The pharmacy may communicate directly with the you to arrange payment and to organise collection or home delivery of the medicines. 

Alternatively, the paper prescription can be sent by post to you. The prescription can then be taken to a pharmacy by a family member or friend.  The Australian Government has announced the interim arrangements for prescribing will remain in place until 30 September 2020, or until full electronic prescribing rollout is implemented.  

If you are on a high dose of prescription opioids, you can also access Naloxone, a drug that can temporarily reverse the effects of an opioid overdose or adverse reaction, as a precautionary measure to minimise your risk of opioid related harm during COVID-19. Naloxone is currently available free and without a prescription in participating pharmacies through New South Wales, South Australia and Western Australia under the Federal Government’s Take Home Naloxone Pilot program. Naloxone is easy to use and available as a Nasal spray, Pre-filled syringe or Ampoules under the Pilot program. Family or household members of anyone using opioids can also freely access Naloxone under this program.