America’s opioid crisis has been one of the defining public health emergencies of the last few years. Overdose deaths had steadily increased year over year until 2017, when the Department of Health and Human Services declared a public health emergency. 140 people per day were dying of drug overdoses, 91 of them due to opioids.
Because of the increased focus the number of deaths actually went down the next year for the first time in decades. 2018 heralded the start of more significant efforts to turn the ship around.
But COVID-19 threatens to undo much of that work. I recently interviewed Matt Deluca, director of clinical solutions at Confidant Health, to find out more about the opioid crisis and its intersection with the COVID-19 pandemic.
Changes In Clinic Availability
Social distancing has hammered people struggling with substance use and opioid use disorders (often abbreviated SUD and OUD). One of the biggest problems is the treatment clinics they’re used to relying on.
“Methadone is one of the lifelines for people who are dealing with OUD, and with the current situation they’re stuck between a rock and a hard place,” says Deluca. “Either they’re staying open and creating an environment where disease can spread or they’re limiting access and people who need access are getting hurt. It’s a bad situation.”
Methadone clinics work to help people in the grip of addiction break free. They’re not the right option for everyone but many opioid users rely on them. When someone signs up for a methadone clinic, they enter a rigorously administered program where the methadone is used to build up a cross-tolerance in the body to block the effects of opiates.
Since opioid addiction puts its hooks so deeply into every part of the body quitting cold turkey can be a horrific experience, and may even be life-threatening. Methadone will mitigate the effects of the withdrawals as it’s given at regular intervals on the premises.
COVID-19 is putting the entire medical system under strain, and these treatment clinics are no different. “People aren’t able to get to the clinic as much, and access has been limited,” says Deluca. “Telehealth has become much more critical because clinics are having to limit contact. Usually that support network is a big part of the treatment program, but it’s compromised right now.”
Telehealth is helping, but not every place is set up for it, and telehealth requires some unique attention to regulatory requirements like HIPAA. And monitoring and support are harder from a distance.
Because of the ongoing pandemic, clinics are in a tough spot. Though the Substance Abuse and Mental Health Services Agency has relaxed methadone rules to allow stable patients to keep a longer supply, clinics are still crowded areas ripe for the spread of disease.
At the moment, the best way for clinics to support those they serve is to do the best they can with telehealth and lean even more on regular contact.
Social Contact
“Addiction thrives when people are lonely,” says Deluca. “Isolation and extra free time are prime triggers for relapses or changes in behavior. To really curtail these sorts of problems we have to focus on keeping our OUD patients in contact with people.”
Contact with other people is something that the world at large seems to be struggling with during the COVID-19 pandemic. Social distancing is taking a toll on people who might be stuck in their apartments by themselves, or at home suddenly with both parents working remotely and the kids kept back from school.
People are figuring out ways to cope, though. Organizing video chats and virtual meetings is one way that the socially inclined are getting their social contact. In areas like Italy there are impromptu balcony concerts each day in cities across the country.
For the most part people seem to be coping, which is probably due to the universal nature of the crisis. But a significant minority is much more vulnerable, and they’re the ones that need the help. Being able to talk with other people, even at a distance, is crucial.
“When those social links start to erode, that’s when we see our patients slip,” Deluca notes.
“Confidant’s better positioned than a lot of other treatment providers because we’re online already, and we’ve been doing our best to maintain and even increase our contact. But it takes more than just OUD treatment providers. It takes family and friends.”
The coronavirus crisis shouldn’t stop us from building connections. It just makes it a little harder. Family and support networks are imperative even for healthy people not struggling with addiction. It’s that much more critical right now for those in the grip of SUD and OUD.
Anxiety can make us change our behavior, fall into self-destructive patterns and lose track of what’s most important to us. Though some people are making the most of their isolation it can’t be an excuse to lose touch.
If you know someone who’s dealing with SUD or OUD, don’t just assume they’re doing OK. Reach out to them and take the initiative. Include them in your Zoom happy hours and your online movie watching sessions. Drop a line to the people you haven’t heard from in a minute. It just might save a life.