The COVID-19 pandemic has demanded a compassionate and creative approach in delivering healthcare to those struggling with mental health and substance use disorders. Declared a nationwide public health emergency in 2017, the opioid crisis is an epidemic affecting people from all backgrounds, and overdose is the leading cause of death in Americans under 50 years old. Although the COVID-19 pandemic has generally worsened mental health, increased the rates of drug use, and strained access to care, the innovations we implement now in order to treat those in need can pave the way to more effective strategies for the future.
People with untreated opioid use disorder are at higher risk for job insecurity, unstable housing, homelessness, and incarceration, all of which can contribute to a higher likelihood of coronavirus transmission due to congregate living facilities where quarantining is difficult. In addition, people who use drugs are known to have higher death rates from COVID-19, potentially due to lung disease. Although mitigation strategies like physical distancing have saved lives, decreased transmission, and are necessary to control the pandemic, the collateral effects that often accompany them, including isolation from family and friends, loneliness, economic impacts of job loss, and lack of exercise, lead to their own serious consequences. Depression is a common trigger for drug use, and the so-called “deaths of despair,” stemming from drug use disorders, alcoholism, and suicide, have increased by an estimated 10 to 60% so far during the pandemic. The CDC found that as of this summer, 13% of all Americans had either started or increased their drug use in order to cope with the pandemic, with overdose rates setting record highs in most areas of the country, including in Washington.
We have decades of evidence that treatment for substance use disorders saves lives, improves health outcomes, and has a positive impact on the community including decreased crime rates, but COVID-19 has complicated the delivery of that treatment to the people who need it. For example, emergency rooms care for victims of overdose, and linking people directly to treatment by starting medication or offering transportation right after such an event has been shown to vastly improve outcomes compared to just providing a referral. As emergency rooms struggle to care for COVID-19 patients with respiratory emergencies, however, their capacity to link patients to care for addiction has suffered. Starting treatment for opioid use disorder has historically required in-person visits, and a viral pandemic complicates the safety of that model.
Regulators made some quick adjustments in the beginning of the pandemic to avoid disruptions in care, including allowing telehealth visits. While this is an important resource to offer and has increased access for many, some of our most vulnerable patients, without the required devices, or without a safe place to use them, remain at risk. Patients with opioid use disorder who need to start methadone, a medication that treats heroin and fentanyl addiction, are also left out of this regulatory adjustment and are required to present for in-person visits to start treatment. With our decreased community capacity for care including emergency room safety nets, the worsening opioid use disorder trends, and the increased risk that COVID-19 poses to this vulnerable group, it is critical to develop innovative methods to reach patients.
At We Care Daily Clinics, we have expanded our open hours and our referral system through in-person engagement with community partners, enabling us to identify at-risk clients and offer them transportation to and from treatment, which is also available to most long-term patients unable to come to the clinic otherwise. We’ve also developed the state’s first medication delivery system in which our nurses and safety team can provide offsite treatment to those at higher risk for COVID-19 complications in order to decrease exposure risk. In the future, a more robust care network outside the walls of our clinic, with assessment and medication offered in a safe and flexible setting, will expand access to care to overcome disparities in outcomes and long-standing structural barriers to proven treatment.
Tom Hutch, MD