As part of our collective effort to keep ourselves, our families, friends, and neighbors healthy during the COVID-19 pandemic, we must consider the impact the virus and our responses will have on people receiving treatment for addiction or in recovery. Simply put, the pandemic has the potential to alter the course of recovery and interrupt treatment, creating a new addiction crisis within this crisis.
“Flattening the curve” and “social distancing” are the watchwords of the day, but recovery is about community, and community requires togetherness. Being apart and avoiding gatherings presents challenges for people receiving treatment and support for substance use disorder. For example, counseling for substance use disorder is often delivered in groups and usually offered in person. Similarly, federal regulations require many people being treated with medications for opioid use disorder to receive their medications in person, often on a daily basis.
Not only that, people with substance use disorder may be especially vulnerable to contracting COVID-19 due to other chronic illnesses, such as heart, kidney and liver disease – all risk factors for the novel coronavirus. Individuals with opioid or methamphetamine addiction are also more vulnerable to lung injury or death.
Apart but not isolated
It’s often said that “addiction is a disease of isolation, and recovery is about connection.” But what does that mean at a time of social distancing? Many in recovery rely on twelve-steps programs like Alcoholics Anonymous and Narcotics Anonymous or other self-help groups like SMART recovery that traditionally meet in person. Participants in these groups and others in recovery rely on each other to support and affirm their recovery. But complying with orders to limit gatherings to fewer than ten means closing down meetings and staying away from each other.
Some meetings have moved online using videoconferencing platforms. Experts say that video conferencing or telephone calls, while not ideal, are preferable to texting, which some believe can create even more of this sense of isolation. Any way that people can stay connected, even if they can’t be in the same room, is a step in the right direction.
Treatment at Home
COVID-19 is also complicating access to addiction treatment, including counseling and medication. Group sessions and even one-on-one in-person counseling risks facilitating the spread of infection and negating the helpful impact of social distancing. Increased use of telehealth is one way patients can receive the care they need without creating additional risks to their health and the safety of their community. While most addiction counseling has traditionally been delivered in person, in recent years telehealth has been expanded to serve rural communities and other patients who lack access to in-person treatment. For patients who need or already receive medication-assisted treatment for addiction, social distancing presents practical challenges to medication access. Federal regulations generally require a physician to examine a patient in person before prescribing a controlled substance. Regulations also require some treatments for opioid use disorder to be administered in person at highly regulated Opioid Treatment Programs. For most patients, that means waiting in line for their dose on a daily basis. The concern would be that, patients will either continue to show up to receive their needed medication, putting themselves and others at greater risk of infection, or they will stop receiving medication and put their recovery at risk. Federal regulators have stepped in to make access easier. Under the national public health emergency declaration, DEA-registered providers may prescribe medications without an in-person examination. And the U.S. Substance Abuse and Mental Health Services Administration is permitting states to make decisions on how to proceed with telehealth services.
We are in the midst of an unprecedented crisis, and we must all do our part to “flatten the curve” and ensure our health system is able to meet the challenge of the COVID-19 pandemic. As we keep our distance to avoid the spread of infection, we must think creatively about ways we can fill the gap to ensure patients with substance use disorder can continue to receive the services they need to stay healthy. Technology and regulatory flexibility are two tools we have available that are making a difference.