Update (2/4/20): The state has deemed drug and alcohol treatment centers “essential businesses” and allowed them to continue operating during the coronavirus emergency. Governor Tom Wolf’s office encourages individuals struggling with substance abuse to call a hotline, 1-800-662-HELP, to get in touch with recovery resources.
The number of calls from people seeking help for both alcohol and opioid use disorders has fallen since the advent of the novel coronavirus, but calls from people seeking help for cocaine and methamphetamine abuse have increased, according to Jenn Smith, director of the Department of Drugs – and alcohol programs. She advised people in recovery to use video calling services to keep in touch with family and friends during this difficult time.
The new coronavirus is changing the way providers are treating in Allegheny County and across the country people with drug and alcohol use disorders, especially those taking medications such as methadone and Suboxone to maintain their recovery.
“This is such a tumultuous time for everyone, especially those with substance abuse disorders,” said Daniel Garrighan, facilities director at Jade Wellness Center, an outpatient treatment center with locations on the South Side, Wexford and Monroeville, offering services such as Suboxone, Vivitrol and ReVia.
Those treatments, plus methadone — all commonly referred to as drug therapy or MAT — prevent cravings and help people stay off illicit opioids. Vivitrol and ReVia can also be used for alcohol use disorders. But they are usually provided during regular office visits, sometimes daily in the case of methadone. The corona crisis has made such visits much more difficult, if not impossible.
“We’ve already dealt with our own epidemic with this subset of people with the opiate crisis,” Garrighan said. “We’ve seen such outrageous fatalities in the last 10 years and we’re just starting to get to grips with it and then something like this happens. We have this social responsibility and we don’t want to neglect it [patients] but we also need to take the necessary precautions with the spread of COVID-19.”
After a record 737 overdose deaths in 2017 in Allegheny County, fatal overdoses in the county decreased by more than 40% in 2018.
Some fear that progress may be jeopardized. “What’s happening with the coronavirus right now,” said Lauren Ballew, a harm reduction specialist at Bridge to the Mountains, “limits resources for everyone: for the homeless, for average users, for service providers, and for people taking drugs. for opiate disorders.”
Less frequent visits
Under normal, non-emergency circumstances, methadone is provided daily in person at an approved clinic. Depending on the patient, Suboxone is given weekly or biweekly.
The Substance Abuse and Mental Health Administration (SAMHSA) recently newly released guidelines for providing this maintenance medication in the midst of COVID-19. Under the memorandum, doctors and clinics prescribing these drugs in areas where a state of emergency has been officially declared will be allowed to dispense up to 14 days’ worth of drugs to patients deemed “less stable” and up to 28 days to patients considered “less stable.” . stable.”
Garrighan said he found the guidelines “very responsible”.
However, some recovery professionals are concerned about the potential misuse of drugs. Abuse of methadone can lead to overdoses, and it can take different doses of naloxone (aka Narcan) to reverse that.
“A single daily dose of methadone taken in the morning is meant to last all day. If someone takes two doses and decides to get high, they’re taking a significant risk,” says Alexis, a drug and alcohol counselor and case worker in Allegheny County who is recovering from a drug and alcohol addiction on a long-term basis, and asked to remember her last name.
Ballew said much of the concern about maintenance drug abuse stems from the stigma placed on patients taking methadone and Suboxone to aid their recovery.
“People think that if people get more than they need, they’ll use more than they should,” she said. She speculated that the fear of abuse “could be an extension of general panic that has more to do with the stigma surrounding various forms of MAT than with what actually happens to the individuals taking these drugs to maintain their recovery.”
“Recovery means many different things,” she said. “It’s not a one-size-fits-all and we need to give people the choice to determine what recovery means to them.”
Virtual visits, stalled targets
Jade Wellness Center and other outpatient and MAT clinics in Allegheny County respond to coronavirus by moving to virtual doctor and therapist appointments using the online platform Telehealth. “We’re promoting the option and about half of our visits right now are virtual,” says Garrighan.
“Some insurance policies don’t cover virtual visits,” he added. “Medicaid providers do, but some private subscriptions don’t. Also, not everyone has access to the internet.”
Other changes taking place at Jade Wellness Center include a no-wait room option for the clinic to message people when practitioners are ready to see them. Jade is also reducing urinalysis out of concern that COVID-19 can be transmitted through the urine.
While making virtual or telephone appointments has clear benefits in preventing the spread of COVID-19, some service providers believe that important information about their most vulnerable customers can be lost in technology.
“When you see someone face to face, there’s an unspoken language of what’s going on, that’s so much more important than what’s being said,” Alexis said.
That’s true in cases where clients still use, as well as those who are sober and pursue life goals.
“If sobriety is maintained and we are [working] on employment or housing goals, there’s not much we can do at this point,” Alexis said. “Each of those things is on hold for them, just like everyone else.”
The trend towards virtual visits also affects the distribution of naloxone, which reverses opioid overdose.
“Normally I give [naloxone] to customers during appointments or leave it at the ambulance, police or even in restaurants. But because of social distancing, we can’t do this very often,” Alexis said.
Prevention Point Pittsburgh is still distributing naloxone and clean syringes from his van. “They’re going to have a big presence with what’s going on,” Alexis said. “I’ve driven people to their sites to get clean needles because they have HIV and hepatitis C.”
For users, increased risk – but also hope
COVID-19 is changing the lives of individuals who still use and have an active addiction.
“Looks like it’s easier to use now because the police don’t pull people out unless absolutely necessary,” Alexis said.
There is no official data on overdoses since the onset of COVID-19, but she speculated that we may see an increase in overdoses due to the closure of some outpatient clinics. She also worried that people with active addiction who contract COVID-19 are at increased risk of overdose. “Overdoses affect the respiratory system for opiate, benzodiazepine and alcohol users,” and the coronavirus affects the same system, she noted.
Ballew added that the panic surrounding COVID-19 and the resulting 911 calls could hamper shipping and slow EMS response time. “With less urgency, phone calls about overdose cannot be handled as quickly,” she said.
“This is a very critical time to be aware of how you’re taking or how someone else is taking to help prevent a fatal overdose,” Ballew said. She stressed the importance of making sure people have naloxone and know where it is.
“We encourage people not to use alone and encourage those who use alone to use the buddy system,” she said. With the buddy system, the person using someone else will text you when they’re about to get high, then follow up 10 to 15 minutes later. If the person who should receive the follow-up text doesn’t hear from the active user, they can contact EMS for help or go see that person themselves.
“What’s happening with COVID-19 is so much like what happened to those who were recovering in Florida during Hurricane Irma: Everyone left or sat down and stayed home,” Alexis said.
When Hurricane Irma hit in 2017, Alexis was in early recovery and living in Florida, having been sober for about six months, when she had to evacuate. Formalized meetings and treatments stopped due to the emergency. She moved to North Carolina, attended meetings, and remained in recovery. She moved in with her then-partner, who was on a long-term recovery and who helped her avoid a relapse during that difficult time.
“I’m afraid of those who recover early and don’t have a support group or sponsor yet,” she said, “because that helped me stay clean during the hurricane.”
Joanna Bernstein is a writer in Pittsburgh. She can be reached at [email protected].
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