ABPM Diplomate Reflects on COVID-19’s Impact on Addiction Medicine Practice

Dr. Fred W. Rottnek, a board-certified Addiction Medicine physician, shared with the ABPM how the pandemic impacted his practice and how his organization is reimagining care for patients when in-person visits are not always possible.

COVID-19 has given new meaning to harm reduction.

As part of my role in Addiction Medicine at Saint Louis University, I am Medical Director at Assisted Recovery Centers of America. While we have moved to telehealth services in recent years, COVID-19 forced us to move to virtual care in a matter of days.

As a clinical team, we had to have some difficult conversations about what virtual care means to a specialty that has relied, likely too often, on urine drug screens and lab draws to give us an albeit false sense of control. In the realities of COVID-19, our team had to come to rapid agreement that access to care and continuity in care had to be prioritized above our comfort level and routine protocols.

COVID-19 destroyed routine.

We shifted to virtual health, including, when there were no alternatives, care via landline telephone. But we also found ways to launch street outreach with our growing homeless encampments.

Now that [we are] realizing that COVID-19 is not going away anytime soon, we’re re-evaluating patient flow in low-contact, virtual, and street outreach service lines. And we’re asking questions like the following:
• How do we balance benefit and risk within patient encounters and treatment plans?
• Where do raise the acuity of care with community-based lab providers and in-person visits?
• How do we extend fills and refills of medications based on patient adherence, patient location, and COVID-19 prevalence in the community?

This pandemic has reminded us of the challenges we have in this work, but it has also encouraged us to do what we do best in Addiction Medicine: Meet the patient in the patient’s life situation, establish trust, create shared goals, and build a positive, therapeutic relationship to assist our patients in building the lives that they want and deserve as human beings.

Read Dr. Rottnek’s article published earlier this year in the St. Louis Post-Dispatch at https://www.stltoday.com/opinion/columnists/fred-rottnek-substance-abuse-is-the-elephant-in-the-quarantined-room/article_680350a7-55e6-5b90-aa54-ddcb591a855e.html.

How has the COVID-19 pandemic changed the way you practice medicine? Please send us your stories; we would love to share them with the ABPM community! Please email your story to Clare Bonnema at [email protected].