b'Injection or Pills? How the Pandemic Affects Treatment for Veterans Who Have Substance-Use DisordersBy Annette M. BoyleClinicians treating substance-use disorder patients at the VAwhether they live in a group home, or have faced a specific dilemma during the COVID-19 pandemic:work in a setting that would increase their exposure and, therefore, the risk How to deal with veterans who need to receive monthlyto healthcare providers. injections at clinics and VAMCs as a critical component of theirBringing a patient in for an injection is a moment of increased risk of trans-therapy. Dealing with barriers to clinic access became evenmission of COVID-19 and we want to more important with recent research showing that injectablesavoid every instance of increased risk we can, Saxon noted. Still, if personal significantly extend time to relapse for those patients. protectiveequipmentisavailablefor the provider and to protect the patient, the risk of infection is very small.SEATTLEAs states and VA facilitiesBehavioral Health at the University ofa lcohol -u sed isordermove out of lockdown and resume moreWashington School of Medicine, bothThe opioid antagonist naltrexone is ap-non-COVID-relatedactivities,physi- in Seattle. proved in both oral and injection for-ciansarereassessingthebestwaytoFor injection medications, it comesmulations for alcohol-use disorder. The treat substance-use disorders in the shortdown to a decision about each individ- oral form must be taken daily; the in-term and in the event of a second wave. ual patient whether bringing a patientjection lasts a month. Many veterans receive monthly injec- inwithsomeexposure[toCOVID- Randomized clinical trials that have tions as a critical component of their19] gives them more benefit than self- compared the injectable to the oral ver-therapy for substance-use disorder, butadministering medication during a pan- sion in alcohol-use disorder have had asmanyclinicsandhospitalscloseddemic, Saxon told U.S. Medicine. mixed results. thisspring,theywereoftenswitchedFactorstoconsiderincludetheArecentretrospectivereviewunder-tooralmedicationsthattheycouldpatientsmodeoftransportation takenattheVA,however,foundthat self-administer.public conveyance or private vehicle,long-acting injectable naltrexone tripled That decision was taken on an indi-vidual basis for the most part, as the VAhadnonationalpolicyinplace intheearlystageofthepandemicMany veterans receive monthly injectionstoguidecareteams,saidAndrewJ. Saxon, MD, director of the Center ofas a critical component of their therapyExcellenceinSubstanceAddiction TreatmentandEducation,VAPugetfor substance-use disorder.Sound Health Care System, and profes-sor in the Department of psychiatry and 2020 COMPENDIUM OF FEDERAL MEDICINE 37'