Dependency treatment shrinks during the pandemic, leaving people with no room to turn

(Conversation is an independent, non-profit source of news, analysis, and commentary from academic experts.)

Elizabeth Chiarello, University of St. Louis

(Conversation) COVID-19 masked the US opioid crisis, but that doesn’t mean that opioid addiction is gone. During the COVID-19 pandemic, the opioid crisis is exacerbated. Overdose mortality increased by 13% in the first half of 2020. COVID-19 threatens to dismantle the already fragile addiction treatment system, causing a crisis on top of the crisis.

The opioid crisis, or more properly, the overdose crisis, has plagued the United States for 20 years. Drug overdose is a leading cause of accidental death, killing 70,000 Americans each year. Opioids kill 130 people every day.

As a medical sociologist who has studied the opioid crisis for the last decade, I have seen the havoc it has brought about. The following shows how COVID-19 deteriorates.

Faint hope, dashed line

Mortality from overdose has steadily increased each year since 1999, primarily due to a reduction in prescription opioid deaths, and decreased by 4.1% in 2018. Experts suggest that lower opioid prescribing rates, increased access to treatment, and increased access to naloxone help explain decline.

This short-term downturn was caused by a sharp rise in excess mortality in 2019 and 2020 due to increased mortality from other drugs such as cocaine and methamphetamine.

Not only are the numbers increasing, but the drugs that cause overdose are changing.

Many overdose deaths are associated with multiple drugs. Prescription drugs are now less important than heroin, cocaine, and methamphetamine. Synthetic fentanyl, a powerful illegal opioid manufactured in the laboratory, poses the greatest threat. It contributes to mortality due to twice the overdose of prescription opioids.

Inadequate addiction treatment

The overdose mortality rate (20.7 deaths per 100,000) is not surprising to those familiar with addiction treatment in the United States.

Only 17% of people with addiction are treated.

And the treatment of addiction is notoriously fragmented and lacking in funding. Apart from mainstream healthcare, the addiction treatment industry is poorly regulated. Quality varies. Only one-third of the institutions provide drug therapy for the treatment of addiction, evidence-based care that reduces the risk of overdose.

If intoxication treatment is inadequate, harm reduction strategies can be effective. Harm reduction scholars recommend that people who use the drug use strategies that prevent them from sharing or reusing the syringe from overdose, infections, and abscesses.

Harm reduction programs include the naloxone program, which distributes naloxone throughout the community, and the syringe service program, which distributes clean syringes to people who inject the drug. While effective, these programs have received lukewarming support, primarily due to stigma. The Naloxone distribution and syringe service programs operate on a small budget with limited time, which became limited only during the pandemic.

Crisis clash

When the COVID-19 pandemic began, the federal government took steps to mitigate its impact on the opioid crisis.

The government lowers the addiction drug barrier by allowing the methadone clinic to take patients back to the drug and allowing doctors to provide another drug, buprenorphine, used for recovery through telemedicine. It was. These measures have reduced face-to-face contact.

But those who deal with disabilities still face challenges. One is the inability to join face-to-face support groups. Social isolation increases the likelihood of drug use and overdose. Although numbers are not yet available, many anecdotal evidence suggests that dealing with a pandemic increases stress and anxiety while disrupting routine recovery-critical routines.

And COVID-19 made the supply of illegal drugs more dangerous. In the illegal market, drugs contain different substances. People who buy heroin can end up with a mixture of drugs of varying strengths, heroin, fentanyl, and oxycodone. People who use drugs usually get it from a known supplier, so they know what they are getting and how much they will take.

COVID-19 interfered with illegal drug trafficking, so fewer drugs entered the country. People do not stop using drugs when supplies are low. They get a drug of unknown composition from a new supplier. If someone buys heroin but unknowingly takes a much stronger fentanyl, the risk of overdose rises sharply. People die because they don’t know what medication they are taking.

Complex of crisis

In addition, COVID-19 exacerbates trauma leading to overdose. Addiction is a “despair of illness”. In short, addiction is more common among people with poor social and economic outlook. Mental health, unemployment and housing insecurity all contribute to drug use.

COVID-19 does less treatment. Treatment centers struggling to stay open save time and train staff. The closure of the Syringe Service Program site and the suspension of the Naloxone program undermine harm mitigation efforts.

Strategies for expanding treatment have helped in several ways. However, only doctors who already have the X exemption (a special prescription for prescribing opioids for addiction) can offer telemedicine to buprenorphine. Although federal action has moved medical care online, there is only marginal improvement in treatment capacity.

Systematic solution

Things are dire, but leaders can now develop effective strategies. In the short term, leaders can double their harm reduction. They cover the community with naloxone and put it in all libraries, gas stations, pharmacies, vending machines and make it as common as a fire extinguisher. They can invest in syringe service programs and encourage people to test fentanyl using drug test strips.

They eliminate the X exemption, allow all licensed doctors to provide the drug, and allow pharmacists to provide buprenorphine, an approach that has shown favorable results in Rhode Island, thereby helping to treat drugs for addiction. The therapy can be expanded. They can expand Medicaid, which requires insurance companies to cover the treatment of addiction. These measures can save lives.

Leaders also need long-term strategies to address the root causes of addiction. As COVID-19 reveals, disrupting drug supply does not eliminate the addiction – it puts addicted people at greater risk. Addiction drugs work well for opioid use disorders, but not cocaine use disorders, so increased mortality from cocaine overdose is of particular concern.

Over the past 20 years, the United States has seen a surge in overdose with prescription opioids, heroin, and fentanyl. Currently, cocaine and methamphetamine pose an impending threat.

Investing in a healthy community is the best defense against overdose. A strong social safety net will improve the underlying problems of addiction, including unemployment, homelessness, and mental health. Building an infrastructure to prevent and treat addiction can prepare a community for a storm like COVID-19.

[Deep knowledge, daily. Sign up for The Conversation’s newsletter.]

This article was republished from Conversation under the Creative Commons License. Read the original article here: https://theconversation.com/addiction-treatment-shrinks-during-the-pandemic-leaving-people-with-nowhere-to-turn-143731..