POST 140. March 9, 2021. CORONAVIRUS. “In West Virginia, they are bracing for the second wave….. Not coronavirus but opioid overdoses, with one scourge driving a resurgence of the other.

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Covid-19 has claimed 93 lives in West Virginia over the past three months. That is only a fraction of those killed by drug overdoses, which caused nearly 1,000 deaths in the state in 2018 alone, mostly from opioids but also methamphetamine (also known as meth).

That year was better than the one before as the Appalachian state appeared to turn the tide on an epidemic that has ravaged the region for two decades, destroying lives, tearing apart families and dragging down local economies.

Now coronavirus looks to be undoing the advances made against a drug epidemic that has claimed close to 600,000 lives in the US over the past two decades. Worse, it is also laying the ground for a long-term resurgence of addiction by exacerbating many of the conditions, including unemployment, low incomes and isolation, that contributed to the rise of the opioid epidemic and “deaths of despair”.

“The number of opioid overdoses is skyrocketing and I don’t think it will be easily turned back,” said Dr Mike Brumage, former director of the West Virginia office of drug control policy.

“Once the tsunami of Covid-19 finally recedes, we’re going to be left with the social conditions that enabled the opioid crisis to emerge in the first place, and those are not going to go away.”

To Brumage and others, coronavirus has also shown what can happen when the government takes a public health emergency seriously, unlike the opioid epidemic, which was largely ignored even as the death toll climbed into the hundreds of thousands…

Public health officials from Kentucky to Florida, Texas and Colorado have recorded surges in opioid deaths as the economic and social anxieties created by the Covid-19 pandemic prove fertile ground for addiction. In addition, Brumage said significant numbers of people have fallen out of treatment programmes as support networks have been yanked away by social distancing orders.

“I’m a firm adherent to the idea that the opposite of addiction is not sobriety, the opposite of addiction is connection. Clearly, what we have lost with the pandemic is a loss of connection,” he said….

You can think of Covid-19 as a hurricane whereas the opioid crisis is more like global warming. It’s happening, it’s slow, it’s dangerous. “(A)

“More than 2 million Americans struggle with opioid use disorder, and about 130 Americans on average die every day from an opioid overdose. Opioids account for a majority of drug overdose deaths, the leading cause of accidental death in the US. It’s a crisis that’s been a priority for officials at the federal, state and local levels for years.

Now, the coronavirus has disrupted all matters of life across the country — including efforts to combat the nation’s opioid problem.

Some who struggle with substance abuse are homeless or incarcerated and can’t comply with social distancing guidelines, while those who can are left isolated and at risk. On top of all that, the pandemic is causing massive stress — a primary driver of relapse…

There are a few reasons that experts are concerned about a potential coronavirus-related increase in opioid overdoses.

For one, harm reduction programs across the country have been experiencing reduced capacity given the pandemic, Heller said.

Though many states have defined such services as essential in their stay-at-home orders, some programs have had to restrict access or reduce staffing because of a lack of funding or personal protective equipment for their workers.

Federal agencies have eased some regulations that have mitigated the risks of overdoses and Covid-19 infection, Heller said.

For example, patients receiving medication-assisted treatment for opioid use disorder often have to visit a provider daily for a dose of methadone. But because such visits could expose both patients and health care workers to Covid-19, the Substance Abuse and Mental Health Services Administration (SAMHSA) is temporarily allowing treatment programs to provide patients with two to four weeks’ worth of methadone doses to take home.” (B)

U.S. opioid overdoses increased 29% in 2020 amid the COVID-19 pandemic, a study finds…

According to latest research, the opioid epidemic did not disappear. Rather, it lurked in the shadows of the coronavirus pandemic, growing in strength and taking advantage of a society now more susceptible than ever.

In a large cross-sectional study published in JAMA Psychiatry on Feb. 3 that analyzed nearly 190 million emergency department (ED) visits, researchers found significantly higher rates of visits to EDs for opioid overdoses during the months of March to October 2020 when compared against the same dates in 2019. The study found that, from mid-April onward, the weekly rates of ED visits for drug overdoses increased by up to 45% when compared against the same period in 2019.

Overall ED visits for opioid overdoses were up 28.8% year over year.

While some survived these overdoses, many others were not so lucky….

The CDC said in December that the rate of overdose deaths was accelerating during the pandemic, driven by synthetic opioids, which rose 38.4% during the year leading up to June 2020.

Opioid overdoses do not exist in a vacuum; rather, any force that threatens mental health leaves society more susceptible to the threat of addictions. For some, this force may be the fear of contracting COVID-19. For others, the stress of losing a job. And still others, the boredom of being trapped in your home with nothing to do.

“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” said former CDC director Dr. Robert Redfield, in December.

This same JAMA Psychiatry study found that emergency department visits for mental health conditions, intimate partner violence, and child abuse and neglect increased during the same time period as did suicide attempts.

While many lives were saved with stay-at-home orders, these savings were not without cost. While vaccines appear to have provided a light at the end of this COVID-19 tunnel, America will need to face its growing problem of social isolation and mental illness in the age of the internet, experts say.

“Social distancing has forced many 12 Step programs, such as Alcoholics Anonymous, to suspend their meetings. The need for an effective treatment for substance abuse has never been greater,” said Linville M. Meadows, M.D., a physician and author on addictions.” (C)

“Numerous factors may be contributing to increased use of certain non-prescribed drugs and dangerous drug combinations during the pandemic. At the onset of the pandemic, to help stop the spread of COVID-19 and prevent further deaths in health care settings, the CDC recommended that health care systems delay elective care.5 Although necessary to help mitigate the spread of the pandemic, these orders appear to have led to one of the most dramatic changes brought on by the convergence of the drug epidemic and the COVID-19 pandemic—the temporary discontinuation of testing for drug and alcohol misuse. The result is that many clinicians continue to prescribe controlled substances without drug testing and are therefore “flying blind,” lacking objective evidence to assess their patients for potential drug misuse.” (D)

“The pandemic is in many ways a perfect storm for anyone who is struggling with substance use disorder. People have lost their jobs. Social and family interactions have been limited. And the pandemic itself is depressing and anxiety provoking. These are all stimuli that can stress the psyche and the finances of someone who has an addiction. In some cases, it could push a person who was getting their addiction under control back toward substance use. In other cases, the pandemic might be the trigger that actually makes someone consider initiating drug use, which could end up becoming an addiction and being harmful.

Another point to consider is that the pandemic took away the attention—from the media, from legislators, from public health agencies—that was being focused on the opioid crisis. We have an addiction crisis in the U.S. that was being discussed quite a bit in 2019 and it seemed like we were starting to inch toward policy solutions. Now it feels like we need to start over again.” (E)

“Absent meaningful and immediate change, the medical community has an opportunity to step up and address the opioid epidemic head on: Large employers of physicians should require their doctors to possess the federal waiver that would allow them to prescribe Food and Drug Administration-approved medications to treat addiction. Physician groups require doctors to have a state medical license and a federal Drug Enforcement Administration license as a condition of employment. Yet, most physician employers do not even ask if their physicians hold the Drug Addiction Treatment Act of 2000 X-waiver required to prescribe buprenorphine, thereby offering tacit approval of a physician’s inability to adequately treat patients with substance use disorder.

As a result of this gross oversight, we are living in a time when only 7 percent of doctors can effectively treat opioid use disorder, and it should be no surprise that only about 10 percent of people in need of addiction medicine in the US receive adequate treatment. All this despite the requisite training being ubiquitous and available for free, including online. The opt-out remains squarely on the table thanks to the medical industry’s failure to normalize this credential.

Most doctors today are employed by large, consolidated groups. And in many areas, only a single hospital is present. Even a narrow requirement, focused specifically on emergency medicine providers, internists, and primary care physicians, could create treatment on demand virtually overnight, especially in the 42 percent of US counties that have no buprenorphine prescribers and where access is almost non-existent…

And we cannot have an honest dialogue on this topic without talking money. It is the reason hospital systems and health care institutions have been slow to build these capabilities. The case is simple: Why compel your doctors to do something that isn’t well-reimbursed or otherwise required? Why risk offending your highest-paid and hardest-to-recruit employees for something that won’t make the biggest profit? Behavioral health is not a hill on which any hospital CEO is willing to die. And it’s not the CEO’s fault: The gulf between payment for physical health care versus addiction and mental health services is only worsening…

Without question, the broader barriers to treatment access should be diminished or eliminated altogether via the legislative pathways currently being explored—but those efforts will take time and the system will still need greater numbers of professionals who can prescribe the requisite medications. The medical community now has an opportunity to be an intentional, proactive part of the solution. If we take these steps now, when the next generation asks how we were able to manage an epidemic amidst a pandemic, we’ll be able to say that we took meaningful action simultaneously on two fronts—and saved countless lives in doing so.” (F)

• A.’Opioid overdoses are skyrocketing’: as Covid-19 sweeps across US an old epidemic returns, by Chris McGreal, https://www.theguardian.com/us-news/2020/jul/09/coronavirus-pandemic-us-opioids-crisis
• B.The opioid epidemic was already a national crisis. Covid-19 could be making things worse, By Harmeet Kaur, https://www.cnn.com/2020/05/07/health/opioid-epidemic-covid19-pandemic-trnd/index.html
• C.Opioid overdoses 29% higher in 2020 than before the pandemic: Study, By Dr. Nicholas Nissen, https://abcnews.go.com/Health/opioid-overdoses-29-higher-2020-pandemic-study/story?id=75785104
• D.The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020, by Justin K. Niles, Jeffrey Gudin, Jeff Radcliff, and Harvey W. Kaufman, https://www.liebertpub.com/doi/10.1089/POP.2020.0230
• E.A crisis on top of a crisis: COVID-19 and the opioid epidemic, https://www.hsph.harvard.edu/news/features/a-crisis-on-top-of-a-crisis-covid-19-and-the-opioid-epidemic/
• F.Once The Coronavirus Pandemic Subsides, The Opioid Epidemic Will Rage, Navdeep S. Kang, https://www.healthaffairs.org/do/10.1377/hblog20200407.290720/full/
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