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With respect to COVID-19 prevention, the Canadian government defines a category of clinically vulnerable people in which those with \'mild to moderate respiratory disease\' and those with a \'weakened immune system as the result of certain conditions or medicines they are taking\' are advised to take extra care 2 Accordingly, patients with chronic opioid dependence should be included in the clinically vulnerable high-risk group Because of the COVID-19 pandemic, they are facing a severe shortage of clean opioids Tyndall makes the important point that physicians in British Columbia have been cautious in prescribing opioid medications despite clinical guidance being provided during the COVID-19 pandemic 1 The cautious approach to prescribing opioid medications may be the result of messages physicians have become accustomed to,3 specifically messages that stigmatize opioids and instill fear in prescribing physicians that their patients may become addicted and ultimately succumb to their addiction 3 It is important to address the discomforts and challenges that physicians have in regard to prescribing opioids and encourage physicians to consider additional factors such as socioeconomic status, mental health and substance use problems when having conversations about opioids with patients 4 We suggest that further resources be created to support physicians in becoming more comfortable prescribing opioid medications, given that most physicians lack proper training to optimally prescribe opioids 5 Recent guidance from the British Columbia Centre on Substance Use, which addresses both the overdose and COVID-19 crises, provides clinical support for prescribing health care professionals, including valuable case studies and microinduction protocols 6 However, additional resources to support health care professionals in reflecting on their positionality in regard to prescribing opioids and in developing additional confidence in their ability to manage the care of patients with opioid use disorder would be a good addition to the guideline
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