Virus creates perfect storm for those with substance-use disorder, but opens the door to online recovery tools that could persist

Image from Alcohol.org
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By Melissa Patrick
Kentucky Health News

Economic struggles and social isolation are well-known triggers for people with substance-use disorders, so the coronavirus pandemic has created a perfect storm for them. But the isolation has prompted an influx of online recovery services that addiction experts hope will continue long after the virus subsides.

“Some really great things that are going to come out of this situation is that for folks who really face transportation barriers, especially out in those rural communities, if we allow, continue to have this space for virtual connection, we can really create some better connections with those people to get them the supports that they need,” Tara Moseley, program manager at Young People in Recovery said on “Coronavirus: A Kentucky Update,” a weekly Kentucky Education Television program hosted by Dr. Wayne Tuckson.

The shift to online care is an opportunity for those who are seeking recovery, but are hesitant to attend an in-person meeting, said Sarah Bell, lead peer specialist at Beyond Birth, a University of Kentucky outpatient substance-use-disorder recovery program serving mothers in recovery.

“I think it is a great time to for anyone who might be exploring getting sober, but they don’t want to walk into a meeting in their town,” Bell told KET. “There are all these virtual meetings now, which I think is really helping to break down the stigma of people who feel like they might want to stop using a substance.”

Addiction experts have long called for more access to online addiction treatment, including the ability to prescribe medications online for opioid-use disorder. About 40 percent of U.S. counties don’t have a health-care who is approved to prescribe buprenorphine, an active ingredient in Suboxone, the preferred drug in medication-assisted treatment for substance-use disorder, according to a federal report.

Online prescribing is possible only because the pandemic prompted the federal government to suspend a law that required patients to have an in-person visit with a physician before such a prescription, Phil Galewitz reports for Kaiser Health News. 

The new rules also allow people who are in treatment for addiction and are considered “stable” to take home a 28-day supply of methadone, and those “less than stable” to have a 14-day supply. Beforehand, methadone could only be administered in an opioid treatment program. Advocates say compliance with the new guidelines has been inconsistent, reports Stat, the medicine-and-science publication of The Boston Globe.

Virus creates perfect storm for relapse 

Since mid-March, all non-life-sustaining, in-person businesses in Kentucky have been closed, public schools have ceased all in-person classes, and Kentuckians have been asked to practice social distancing and be “healthy at home” to slow the spread of the coronavirus. Such measures, while saving lives, have wreaked havoc on the economy and thrown people with addictions into a tailspin as in-person recovery supports have shuttered.

“Research shows that job loss is associated with increased depression, anxiety, distress, and low self-esteem and may lead to higher rates of substance use disorder and suicide,” according to a recent poll for the Kaiser Family Foundation, which notes, “A broad body of research links social isolation and loneliness to both poor mental and physical health.”

The poll found that 45 percent of U.S. adults said their mental health has been hurt by worry and stress over the virus.

A U.S. Department of Labor report shows that Kentucky (except tourism-dependent Hawaii) leads the nation in percentage of workforce that has claimed unemployment benefits. The Louisville Courier Journal reports that about 590,000 Kentuckians, or about 29% of the state’s workforce, have submitted new jobless claims in the past six weeks.

“Quarantine and stuff, it causes anxiety, and anxiety is a trigger for a lot of people,” Rebekah Bowman, women’s group leader at Celebrate Recovery, a faith-driven, 12-step recovery program, said on the KET show.  “And sometimes the alienation, that’s a trigger for some people. And the hopelessness of it, some people just get to feeling like it’s never going to end.”

Alex Acquisto of the Lexington Herald-Leader has reported in detail on this topic, telling the stories of Kentuckians who are working to stay sober while being asked to isolate. One is Jaden Korse, 23, who told her that he normally attends at least three recovery meetings a week.

“For a lot of people, me included, prior to relapse, isolation is sort of a trait you’ll see,” Korse said.  “It’s weird to forcibly be put into that, [since] it was something many of us would do in active addiction.”

Drug use continues

Rob Sanders, commonwealth’s attorney in Kenton County, told columnist Salena Zito that even though arrests are down dramatically in his county, he didn’t think drug use was.

“I would estimate that we normally would get 20 to 30 felony drug-possession arrests per week in this county,” he said. “Right now we’re averaging five or six, maybe. Short of crashing into a police car, you are very hard-pressed to get yourself arrested for drug possession . . . I don’t think the drug users have stopped using just because of the coronavirus. I suspect there’s a lot of rampant drug use right now and there’s just a lot less police intervention. I’m not faulting the police, because I wouldn’t want them to have any more interaction with strangers than they absolutely had to, but their proactive policing is way down.”

Sanders isn’t likely far off in his assumption, since illicit drugs continue to flood into the state, news reports in the past month indicate.

In the past month: WKYT reported May 2 about nine straight days of methamphetamine seizures in Whitley County; WYMT reported April 9 about a meth bust in Johnson County; The Daily Independent of Ashland reported April 7 about a seizure of more than a pound of heroin in Boyd County, an amount the sheriff said was almost unheard of locally.

Meanwhile, drugs continued to reach users. The Richmond Register reported April 24 that the Madison County EMS saw 75% more overdose calls April 1-23 than during the same period 2019.

Paul Brethen, co-founder of SoberBuddy and a certified addiction specialist for more than 20 years, told Dawne Gee of Louisville’s WAVE-TV that he believes the supply and distribution of most drugs was being altered because borders closed because of the pandemic: “Drug dealers to keep business going are cutting the heroin and cocaine with fentanyl,” which could lead to more overdoses.

Drug shortages can also lead to overdoses, because users will substitute drugs they’re less familiar with, or change their habits, making dosing less reliable and potentially causing a spike in overdoses,
Daniel Ciccarone, a medical professor at the University of California-San Francisco, told Lois Parshley of National Geographic. Ciccarone fears that the pandemic may usher in a fifth wave of the opioid crisis.

Help is still available.

“A big part of recovery is telling on yourself; you are going to always have thoughts about picking up a drink or a drug,” Bell, of Beyond Birth, said on KET. “If you say it out loud, and talk to someone else about it, it’s going to take a lot of that power away. The more you kind of try to sit in isolation and stuff it and stop thinking about it, or think that you’re wrong or guilty for thinking about it, it’s going to be a lot tougher to  kind of make it through that craving.”

Here is a list of free online meeting options, as well as platforms where individuals can interact virtually with others in recovery, provided to Operation Unite by James Carroll, director of the White House Office of National Drug Control Policy. Kentucky also offers a website to connect Kentuckians to addiction treatment, findhelpnowky.org.