It has been an eventful couple of years for public health departments around the country. Not only are health officials recalibrating to life under the global COVID-19 pandemic, but they are doing it amid the backdrop of a nationwide opioid epidemic. In 2018, 67,367 people died of drug overdoses in the U.S. according to the CDC and almost 70% of those deaths were attributable to opioids.
Focus has shifted intensely toward the novel coronavirus throughout the last five months, leaving the opioid epidemic as a lower priority in budget-restricted county health departments. As cash-strapped states release budgets for the next financial year, the belt will tighten further. Some $26-million that had gone toward substance abuse programs in 2019-20 has been cut from Colorado’s state budget for next year. California is facing $53-million deficit going into the new financial year, and negotiations between the legislative branch and Governor Newsom on how to balance the budget are underway. It was announced this week that a deal had been reached to avoid $1-billion in cuts that would have affected substance abuse programs.
The Trump administration issued an emergency declaration in March stating that it no longer required patients to meet with a physician in person to be prescribed Suboxone and other drugs that help with opioid withdrawal. Instead, patients can now use teleconferencing to connect with a doctor, and in some cases can receive larger quantities of methadone and buprenorphine to prevent having to return to the clinic daily.
Dr. David Fiellin, an addiction expert at the Yale School of Medicine, told the NY Times in March that he is concerned about the impact COVID-19 is having on opioid use disorder patients. “The disruptions that the pandemic is causing can really risk devastating the gains we’ve made in addressing the opioid epidemic,” Fiellin told the Times. “For some patients, we worry about them going back to what is familiar — using is their coping strategy. For others, we worry about disruptions in ongoing access to their addiction treatment medications.”
The American Journal of Managed Care published a paper this month that notes that social distancing may be ‘concealing a surge of opioid abuse.’ The paper describes the pandemic as an unanticipated haven for the already formidable opioid epidemic. It cautions that ‘protective shelter-in-place orders have pushed individuals battling sobriety into isolation’ and that patients have decreased access to treatment and opportunity for distraction from addictions.
It is not just the addiction community that is issuing warnings on the impact of the pandemic on substance abuse patients. Think tanks are also calling for state governments to do more to help those suffering from opioid use disorder.
The Brookings Institute released a report this week advising states to invest in three intervention strategies. The first is to increase insurance coverage and payment for opioid and other substance use disorder treatment services. Secondly, Brookings advises increasing the capacity of treatment services. And lastly, to improve the quality of treatment. The report expounds that payment reform and delivery integration can “fundamentally modify the type of care patients receive, not just for OUD, but for substance use disorders more generally.”
Programs like what Brookings is advocating are expensive and will require an economic commitment from the state government. They will also require focus and vigor from public health departments to implement them.
“When we provide treatment, we talk about relapse triggers,” Dr. Tim K. Brennan told the Times recently. Brennan is the director of an east coast addiction center and has grave concerns about the impact of a pandemic on a public health epidemic. “I’m hard-pressed to think of a bigger relapse trigger than what we’re going through now as a country.”