A couple of months ago, the most talked-about public health epidemic in New England was opioid addiction. While the COVID-19 pandemic has since taken over, the drug crisis has not gone away. But addressing it has become much harder.
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In the best of circumstances, addiction is incredibly challenging to treat. Add in the anxiety of a global pandemic, and the distance it's putting between people, and drug abuse becomes an even greater risk.
“What I'm hearing about is mental health and isolation, and fear and trauma, and how that could exacerbate substance use,” said Cherry Sullivan, who runs Hampshire Hope, a coalition within the Northampton, Massachusetts, health department that addresses opioid addiction.
Normally, Sullivan would stress the importance of human connection in the recovery process.
“We are in a time where in-person connection is difficult,” she said. “It can be done, but there are a lot of restrictions, and it can be scary for people.”
Hampshire Hope oversees a program called DART, or Drug Addiction Recovery Teams, where police officers and recovery coaches reach out personally to drug users after an overdose or other crisis.
But in the pandemic, DART has had to scale way back.
“We are going back to former participants and giving them calls — tried to check in with them, see where they're at, if they have any new challenges or new leads,” Sullivan said. “But outreach does have to be limited.”
Sullivan said there's no more door-knocking, only phone calls.
If a police officer responds to an overdose, they'll try to revive the person with Narcan and leave extra with the family. But they don’t go back again.
Instead, recovery coaches are calling clients more often.
“Really trying to make sure that people feel some level of connection to another human being, even if they can't see them in person, is really important,” Sullivan said.
Drug users can be especially vulnerable to COVID-19. Some are HIV-positive. Others have chronic disease from years of substance abuse or homelessness.
And if they do get the coronavirus, that could make them more susceptible to a fatal overdose, according to Liz Whynott, director of harm reduction at Tapestry Health.
During an opioid overdose, “the person stops breathing, and then if the person already has trouble breathing because of the respiratory infection, that adds a whole other layer of worry,” Whynott said.
Tapestry normally gives drug users clean needles and Narcan at its community clinics. But to reduce the risk of exposure, the organization is shortening clinic hours and moving to mobile health care.
Whynott said staff members drive vans around to the places in western Massachusetts they expect drug users to congregate.
“People will see that we're there, and we are doing everything outside of the van in order to minimize contact with the people that we see,” she said.
At the same time, Whynott said it's been challenging to educate drug users — especially those who are homeless — on staying apart from each other, because Tapestry staff don't want to spend much time in conversation. But over the past couple of weeks, she said people seem to be practicing more social distance.
What keeps Whynott up at night is the prospect of having to close Tapestry entirely, either by state decree, or because of staff shortages. She said that's not an immediate threat, and for now, they've shortened work shifts while paying staff the same amount.
But even beyond the services that keep drug users safe, people in the addiction field are trying to hang on to the services that keep people sober.
“Most people are getting treatment for their addictions still, although the whole thing feels fraught and scary,” said Ruth Potee, medical director of drug treatment for Behavioral Health Network.
Potee is doing most appointments through phone and video. And she's been able to prescribe addiction medication for longer periods of time since the state relaxed its prescription rules, “in order to not have people grouped together every morning in a line receiving methadone,” Potee said.
That's the good news. But drop-in recovery centers have closed, so 12-step meetings and counseling are being done virtually. And detox centers are under immense stress.
“People live in very close environments,” said Potee, who oversees several treatment centers. “And so we're desperately trying to keep people with social distancing and hand-washing and keeping everybody well within the unit.”
To keep people apart, Potee said they don't fill as many beds, and that means fewer people can get into detox.
What's more, many places where people go after detox, like halfway houses, are not taking anyone new.
“They're trying to protect their bubble of healthy people, and not exposing them to new people coming in,” Potee said. “You can imagine how the pipeline starts to get clogged.”
And if people stay in detox longer than usual, the insurance companies will stop paying, and that could make it hard for the centers to stay open.
Two insurance companies reached for this story, Tufts Health Plan and Blue Cross Blue Shield of Massachusetts, said they are supporting people with substance use disorder, and are aware of the strain on providers. But they did not say whether they would pay more during the COVID-19 crisis.
Meanwhile, Potee has another big concern: that the supply of addiction medication could be strained. Many prescription drugs come from China, where manufacturing has been disrupted.
“We're all very worried about shortages and drug manufacturing, and specifically with buprenorphine [also known as suboxone] and with methadone,” Potee said.
Potee just hopes the health care industry, as well as the population at large, saves some compassion for the epidemic that started well before COVID-19, and will be here after.