As coronavirus rages on, the opioid epidemic does too

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As fears of COVID-19 sweep across the United States, many people have been forced to stay home and isolate for months. Away from jobs, friends and many loved ones, this quarantine has proven mentally challenging for everyone. And for those battling drug addiction, the ability to fight this highly contagious illness, along with the urge to use, could have more longstanding consequences.

“With the stay-at-home orders, the isolation, for people — especially in recovery, especially newly recovering people — the first year of recovery, they've really lost their entire support network,” said Dr. Deni Carise, chief scientific officer at Recovery Centers of America.

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In 2018, the National Survey of Substance Abuse Treatment Services reported that there were 14,809 substance abuse treatment facilities operating in the United States. For that same year, SAMHSA suggested that 21.2 million people aged 12 or older needed substance use treatment, which is roughly 1 in 13 individuals in the U.S. And in-person meetings and community connection is a huge part of post-addiction recovery.

Since the arrival of COVID-19, that type of treatment has become much more difficult. A process like Narcotics Anonymous and other 12-step or recovery programs created to hold people accountable to their community and peers are now moving to a virtual space.

Carise said that since the outbreak, the addiction community is trying to find new ways to maintain the connection they need using virtual outpatient services. Some experts say that type of connection can be difficult and often overwhelming for those in recovery to navigate.

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“Recovery is connection,” said Brian Corson, founder and executive director of MVP Recovery Now.

Corson, who is in long-term recovery, founded MVP Recovery Now, which is a sober living community in rural Pennsylvania. The group operates 20 recovery homes with about 125 people in the community. It’s designed for people who are just coming out of treatment where residents typically stay nine to 12 months.

"We focus on life skills,” he said. “It's necessary for someone to continue to be successful in long-term recovery."

MVP Recovery Now is fortunate in that they’re able to continue with house meetings and connected activities within group homes during the coronavirus pandemic. But for those who are not as fortunate, there is an even bigger threat of relapse. Corson said that the danger of relapsing from addiction is comparative with contracting coronavirus.

“If you look at the numbers when it comes to contracting, and then recovering from COVID-19,” said Corson, "those numbers are a lot better than if somebody goes back out and starts active addiction.”

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In 2018, the Centers for Disease Control and Prevention (CDC) reported that over 67,000 Americans died from drug-involved overdoses. Of that number, nearly 47,000 died from an overdose related to opioids. These figures have been deemed successful because it was the first year where total drug overdoses — in particular opioid overdoses — have decreased.

At the end of 2019, the Department of Health and Human Services granted more than $9 billion to states and communities to combat the opioid crisis. The data suggest that increased funding, access to treatment, and knowledge surrounding the epidemic was helping even the hardest-hit communities.

Dr. Berta Madras, a psychobiologist with Harvard Medical School and McLean Hospital, said that in this world of distance medicine that easy access is being challenged.

"I think it has created a much heavier burden on people with substance use disorders than would be created under normal conditions,” said Madras. “There is a tremendous fear to show up in person and seek help, medical help.”

She also suggested that many of the issues that coronavirus has exacerbated in the addiction community could last even after the virus has subsided.

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“I think the isolation, the stress, the fear, the lack of social supports, are all feeding into another storm,” said Madras. “That's brewing for people with substance use disorders. I'm very concerned about it.”

Experts say the long-term ramifications of the coronavirus i.e. the lack of routine, job loss and overall anxiety, could create a wave of relapses that might mirror the spike in overdose deaths seen in 2016. They have started to call these cases “deaths of despair” and indicate that those who struggle with addiction will feel the social and economic impact of COVID-19 the hardest.

“In the midst of this isolation, in the midst of everything that's going on in our communities, things have the potential of getting worse,” said Corson. “And we need to have the proper resources, funding and support to be available on the other end of this.”

Madras agreed that it's a reality both the medical community and policymakers need to accept and get a jump on in order for the country as a whole to recover.

“I think that we have to recognize that and we have to accommodate and adjust to it, otherwise we're going to have much greater problems than even in the past,” she cautioned.

Another element of surprise may be the lack of immediate reporting surrounding drug and overdose deaths. The research on overdoses published by groups like SAMHSA and the CDC are at least a year old — meaning we may not know how virtual recovery treatment and the overall drug epidemic during COVID-19 have affected Americans until well into 2021.

Like with most of the coronavirus-related problems, the solution is unclear. Experts agreed that the focus on jobs and job creation — in addition to continued treatment efforts — is one way to try and head off the problem before it becomes too large.

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"I do think that having a focus on jobs, having a focus on social supports, that our opioid commission reports stressed," said Madras. "I think we have to recognize that this is something that is going to be a critical component in our ... nation's recovery overall."

And in the meantime, Corson said that helping someone in recovery can be as simple as giving them a phone call.

“Just check in on them, see how they're doing. And be someone on the other end.”