With the lethality, availability and use of stimulants all greatly increasing in the U.S. in recent years and the COVID-19 pandemic complicating the treatment landscape for patients and practitioners alike, it’s critical for providers to weather the storm, Deni Carise, PhD, chief science officer for Recovery Centers of America, told Cocaine, Meth & Stimulant Summit attendees in a Saturday session.
The rise of stimulants this decade have created a fourth wave in the nation’s substance use disorder epidemic, Carise said. An increase on the supply side has gone hand-in-hand with rising demand: From 2012 to 2016, Colombian production of coca more than tripled, prices fell 23% and the purity of cocaine produced improved by about 20%. From 2012 to today, the number of hectacres on which coca is grown in Colombia has swelled from 78,000 in 2012 to 212,000 today.
During that time frame in the U.S., cocaine overdose deaths have more than tripled since 2012, and methamphetamine-involved deaths have increased nearly five-fold. A national HIDTA report for 2017, meanwhile, found that 83% of seizures of illicit substances by law enforcement were cocaine and 14% were methamphetamines.
Complication created by COVID
With these numbers as a backdrop, the COVID-19 pandemic, which was declared a national emergency on March 13, has created an environment that exacerbates already troubling trends, Carise said.
To wit, Addiction Policy Forum surveyed 1,079 individuals from April 27-May 8, 54% of whom were individuals in recovery, along with families, patients and people with active substance use orders. Nearly three-quarters of the respondents said they had experienced a negative change in emotions since the start of the pandemic, with 87% of those reporting a disruption to treatment as a contributing factor to changes in their emotional state.
Research conducted by Gloo on behalf of the Collaborative Advancement of Recovery Excellence, meanwhile, found that 62% of provider organizations had a decrease in admissions (6% stopped accepting patients entirely) and more than half said their revenue was either down significantly or down to a degree that could lead to potential closure of their facilities. In separate surveys, Gloo found that 49% of providers said the overall recovery and mental health of those they were serving was declining in May/June. In the latest round of polling, which began in September, that number has swelled to 60%.
Carise outlined keys to supporting the field through the remainder of the pandemic.
Stay open. Of patients surveyed by Addiction Policy Forum, 34% said they have experienced changes or disruptions in access to treatment or recovery support, and 14% said they have been unable to receive services. “Folks need you,” Carise said. “Look for government opportunities, find workarounds, do telehealth. Stay safe, but stay open. People really need you.”
As providers look for financial relief, Carise noted the Phase 3 General Distribution of the CARES Act Relief Fund, which provided $20 billion for frontline providers financially impacted by the pandemic.
Use technology. Since September, 43% of Gloo survey respondents are now providing more than 75% of their services via telehealth. Carise lauded practitioners for having a good attitude about making the changes on the fly. Carise said it will be important for the temporary expansion of telehealth that was created as part of the emergency declaration in March to remain in place post-pandemic for several reasons:
- It allows smaller residential programs that don’t have or can’t afford to have a psychiatrist on staff to continue providing psychiatric services on a part-time basis, which is crucial for patients with co-occurring mental health disorders
- It provides a pathway to care for patients who are unable or unwilling to seek treatment in person
- It provides a more comfortable environment for patients in recovery who have relapsed and are apprehensive about being judged in an in-person setting
Endorse harm reduction. Carise recommends increasing, encouraging and teaching harm-reduction best practices.
Show understanding. It’s important to remember that many have lost access to 12-Step meetings and other in-person resources and supports during COVID-19, she said.