As 2020’s unprecedented challenges carry into a new year, addiction and substance abuse have almost predictably been on the rise. In particular, America’s already alarming opioid crisis has seen an upturn.
More than 40 U.S. states have witnessed an increase in opioid-related mortality during COVID-19’s spread, according to American Medical Association Advocacy Resource Center data. And CDC research suggests that opioid fatalities rose by 10% during the early days of the coronavirus. While the root causes behind the numbers are complex, there’s little doubt that the viral contagion has exacerbated the chemical one.
“In the emergency room, we’re seeing people come in with mental health crises, because of isolation and no peer group to meet with,” says Allina Health physician Katherine Katzung, who works at Minneapolis’ Abbott Northwestern Hospital. “People are turning to alcohol and self-medication for depression. Never underestimate anxiety and stress, and the physical manifestation of using substances for coping.”
On its own, chemical dependency can isolate individuals from supportive family and friends, and the disconnect can grow exponentially due to pandemic safety measures. Katzung, whose expertise combines emergency medicine, toxicology, and addiction treatment, has witnessed the effects in Minnesota.
“We are seeing an increase in overdoses since the pandemic has hit, a lot of them accidental because of fentanyl,” says Katzung. “Some of these patients also have a more difficult withdrawal because it’s been harder for them to get on interventions such as suboxone.”
Suboxone has proven to be an effective treatment for opioid addiction, whether from heroin or prescription painkillers (or, often, both). It can be prescribed by physicians and is actually a combination of two drugs that work together to reverse the effects of opioids as well as manage withdrawal. But it’s no miracle cure. Ideally, it needs to be administered under medical supervision—and as a step toward treatment that can foster a more long-term freedom from use.
Katzung’s team is using foundation grants to work toward what she calls a “bridge” clinic that combines suboxone intervention with subsequent resources, so that the person suffering addiction can access effective treatment once they’re stabilized from dangerous withdrawal.
“We could previously see people in the ER and point them toward resources,” Katzung explains. “But it could take them months to get in. Today we can get them into our clinic and then monitor their care. In addition to their primary care, we can bridge them into long-term help with a social worker. We have a list of resources we draw on.”
Of course, the work of Katzung and others in the field was challenging before COVID-19. But the coordinated care model physicians are using for addiction has benefited from recent technological progress. Follow-up care through robust telemedicine at primary clinics has helped patients maintain weekly contact, she says, but the challenges aren’t going anywhere.
“Methamphetamine is a constant, prevalent problem,” she says. “We still see a significant number of patients because of it. And it’s not something I can give you a medication for to stabilize you and get you into treatment.”
Anecdotally, some patients have visited the ER after mixing meth and opioids, such as heroin and fentanyl. (Of the potency of the latter, Katzung quotes a toxicologist who tersely said, “You just don’t know what you’re getting.”) More intravenous drug use has created an uptick in skin infections and abscesses, as well as a dangerous heart valve infection called infective endocarditis.
Katzung is convinced that the best hope for tackling rising addiction rates is meeting patients where they are. “When they come into my Emergency Department, we’re looking at all we can do to help,” she says. “Other providers also are starting telemedicine for continuity of care. We’re seeing people in rural areas stabilized enough to reach out through telemedicine programs, to refer to a warm handoff and a safe place to land in the hospital. We were developing all of this before. Now the pandemic has led to expediting all of these advances in care.”
If you or someone you know is struggling with mental health issues or substance abuse, call 1-800-662-HELP to reach the Substance Abuse and Mental Health Services Administration’s National Helpline, more at samhsa.gov