Not unexpectedly, the length and uncertainty of the COVID-19 pandemic has led to an alarming increase in behavioral health issues. From depression and anxiety to substance use and abuse, individuals are either experiencing behavioral health issues for the first time or relapsing into harmful behaviors.
We are already seeing alarming statistics. Nearly one-fourth of people age 65 and older surveyed by the Kaiser Family Foundation reported anxiety or depression in August, a fairly consistent rate since March – and much higher than the 11% reported by older adults with Medicare in 2018. According to the JAMA Network, a 2020 RAND Corporation American Life Panel two-wave survey showed increased alcohol consumption among women, younger people, and non-Hispanic White individuals. NBC News says that the U.S. is on track to reach an all-time high in drug overdose deaths, partly due to COVID-driven stress, isolation, and disrupted treatment and recovery programs.
Like a perfect storm, the novel coronavirus pandemic has fed the U.S. opioid epidemic. The National Institute on Drug Abuse (NIDA) estimates that 1.6 million people experienced opioid use disorders (OUD) in 2019, but just over 18% received medication treatment for their drug misuse. While the numbers are not fully tallied for 2020, NIDA warns that “[b]ecause opioids negatively impact lung and heart health, people who use opioids at high doses may be more susceptible to COVID-19 and the illness may be more severe. People who have an OUD also face separate challenges to their respiratory health.”
According to the American Medical Association (AMA), more than 40 states have reported increases in opioid-related mortality this year as well as ongoing concerns for those with a mental illness or substance use disorder. The pandemic has halted in-person recovery meetings and led to the closing of some detox facilities. Yes, the odds seem stacked against those struggling with existing or new opioid misuse. However, experts are recognizing the unique situations they face – and are taking action on local, state and federal levels.
Help from multiple angles
OUD has a devastating impact on individuals, their families and friends. It also affects our communities and businesses. While we wait for vaccines to slow the pandemic and better treatments to reduce the death toll among those infected, there are steps we can take to help address the “other” surge—in the opioid crisis. Here are a few recommendations:
- Policy stakeholders should collaborate to develop cost-effective, clinically sound delivery (e.g., telebehavioral health) and financing plans to get medications, behavioral therapies, and recovery support services to isolated and/or low-income individuals.
- Opioid treatment programs, provider groups and state agencies should identify and implement necessary changes for accreditation, to increase available assistance more rapidly for those in need.
- Healthcare organizations, professional associations, research institutions and universities should develop and provide training, curricula, and education materials, so medical and substance abuse professionals can more easily identify OUDs and use the correct skills to meet the challenges exacerbated by the pandemic.
- Federal agencies, state governments, medical groups, community coalitions, law enforcement agencies and non-governmental organizations must continue their work to ensure the appropriate use of prescription opioids and to curtail opportunities for misuse and abuse.
Access to evidence-based care
At its special meeting in November of this year, the AMA adopted a report revealing that the majority of patients still do not receive evidence-based care for substance use disorders. The organization advocates for removing barriers to care and increasing physician training to administer buprenorphine in their offices to help treat OUDs.
The AMA is seeking more federal grants for states to treat opioid and other substance use disorders, as long as those states prohibit drug courts, recovery homes, sober houses and correctional settings from denying entry or care to patients receiving medication for an OUD or other chronic medical condition. It is calling for expanding and integrating primary care services for patients receiving methadone maintenance treatment (MMT) and is urging payers to reduce administrative burdens such as prior authorization to make it easier for OUD patients to receive medically necessary services.
A whole-person approach
Speaking of clinical services, medication assisted treatment (MAT) seems well suited to opioid use disorders during the pandemic. MAT is an integrated and customized approach that ideally involves pharmacological therapy, provider and community educational interventions, integration of OUD treatment with other medical and psychological treatment, and counseling and behavioral therapies. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that this approach has positive outcomes, such as:
- Decreased need for inpatient detoxification
- Higher patient survival rates
- Greater treatment retention
- Reduced illicit opiate use and criminal activity
- Heightened patient ability to obtain and sustain employment
- Improved birth outcomes for pregnant women with substance use disorders
Medications used in MAT for individuals with OUD include buprenorphine, methadone and naltrexone to reduce dependency and naloxone to avert overdose.
The National Center for Biotechnology Information is optimistic about MAT: “Models of care that integrate MAT in primary care and other healthcare settings have the potential to expand access to OUD treatment and decrease the personal and societal impact of OUD.” There are both practice-based models (involving a single clinic), and system-based models, (providing services within a health network or system). In their fact sheet on MAT, The Pew Charitable Trusts call MAT “the most effective treatment for OUD,” even if individual plans require multiple types of therapies and/or drug trials.
Shine a light of optimism and action
Patients and their healthcare partners are finding ways to manage their chronic diseases during the pandemic. It cannot be forgotten that addiction is one of these chronic diseases, and it can be managed, even into recovery. We must remain determined to confront the complications that the novel coronavirus has added to our opioid crisis, to provide hope and treatment to this highly vulnerable population.
Anton C. Bizzell, MD, is the founder, president and CEO of The Bizzell Group, a strategy, technology, and consulting firm. He is a former a medical officer in the Division of Pharmacologic Therapies in the Center for Substance Abuse Treatment at SAMHSA/HHS.