The estimated three million Americans suffering from opioid use disorder (OUD) have been put at increased risk by many of the guidelines established to prevent the spread of coronavirus, according to advocates.
Face-to-face counseling services are no longer available, and some methadone clinics are shutting down, which could increase the mortality risk of OUD sufferers, reports Forbes and the National Institute on Drug Abuse.
Some patients have long feared what would happen if their treatment became unavailable.
Leslie Beckham, in an interview with Buzzfeed News, said “in-recovery” patients on methadone have long feared what would happen if an “apocalypse” prevented them from getting doses.
“It’s kind of a running joke, but now it’s serious,” Beckham said.
Opioid overdoses took the lives of more than 300,000 people during the decade that ended with 2018, the last year of complete federal data available, the Wall Street Journal reports.
“I suspect there will be a lot of relapses — and with a lot of relapses, there’s going to be an uptick in overdoses,” said Danny Pont, who is part of an opioid treatment program in Rhode Island.
Poverty, unemployment, and homelessness are all conditions that are highly correlated with opioid use disorder, according to a 2018 US Department of Health and Human Services study, Forbes reports.
The requirement to self-isolate or shelter-at-home is a further complication that adds to the psychological stress of substance-abusers.
In order to face the challenges that come with the COVID-19 pandemic, the federal government, in combination with the US Substance Abuse and Mental Health Services Administration (SAMHSA), recently relaxed rules to allow more methadone for opioid treatment to be handed out at once.
It’s now accessible to take home in a 28-day supply.
Those receiving OUD treatment are urged to use telemedicine and phone calls to replace in-person visits.
Nevertheless, some methadone clinics “are still required to perform a thorough in-person physical exam before starting patients on that anti-addiction drug,” according to Pew Charitable Trusts.
The federal government is also now allowing treatment-program workers to deliver methadone and buprenorphine “when patients can’t visit the clinics,” the Wall Street Journal and Medscape report.
Dr. Sarah Johnson, the medical director at Landmark Recovery, a network of addiction treatment centers based in Louisville, Ky., told Buzzfeed News that she was “blown away” by the new recommendations, as the changes seemed “dramatic.”
“It’s like the Wild West,” Johnson said. “In the matter of a one-week period, this went from one of the highest-regulated areas of medical practice to an area where there were lots of exceptions to rules that have been in place since the ’70s.”
However, people receiving OUD treatment and advocates alike say rules have been applied unevenly, and in some areas, the changes are impossible to carry out, the Wall Street Journal and Buzzfeed News details.
Seamus Limato, a New Yorker who is receiving OUD treatment, told the Wall Street Journal that he had to visit a Brooklyn clinic in late March to get methadone, “despite being sick and symptomatic with a test-confirmed case of Covid-19.”
While Limato said he wore a mask to the clinic, and was sequestered at a hotel at the time, he said there was no delivery option for him to get his medication.
Given the new guidelines that require clinics themselves to provide home delivery for anyone who doesn’t have a third party distributor able to send the medication, Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) in New York, said this is far beyond the capacity of the clinic staff, according to Buzzfeed News.
Schorr also spoke with reporters at Pew, saying “Every day we use our best clinical judgment to limit transmission of the virus. But at the same time, we’re trying to keep our patients in treatment and protect them from overdose. It’s a balancing act, and it’s extremely challenging.”
Schorr said COMPA was seeking help from state and federal agencies to meet the needs of OUD New York sufferers.
Linda Hurley, CEO of CODAC Behavioral Healthcare, a nonprofit addiction treatment provider with eight clinics in Rhode Island and one in Massachusetts, told Pew, “We’re doing what we have to do for patients, but someone soon will have to help us if they want us to continue.”
In general, addiction treatment facilities, physicians and advocates are continuing to encourage people suffering from opioid addiction to seek treatment, despite risks related to the coronavirus crisis, Pew reports.
Additional Reading: Protecting the Homeless Called ‘Urgent Issue’ in Pandemic.
Andrea Cipriano is a TCR staff writer.