People with a substance use disorder face additional challenges during COVID-19 pandemic

Nalxone, also referred to by brand name Narcan, is a medication used to reverse an opioid overdose. VCU Capital News Service/Flickr/Creative Commons

Since the COVID-19 pandemic reached Iowa, it’s gotten a lot quieter at the Iowa Harm Reduction Coalition’s Cedar Rapids office.

But just because fewer people have been accessing services does not mean drug use is down, IHRC executive director Sarah Ziegenhorn said.

“At first our requests for home deliveries went up quite a bit, and now we’ve seen a demand for all of our services slow down across all domains,” Ziegenhorn said. “Now, I know that’s not because people have suddenly stopped using drugs. It’s because people are trying not to leave their houses as much. There’s also sort of an assumption that we must be closed so lots of people who do come to our office for services are really, really surprised that we’re still open and that we’re still offering services.”

IHRC has been trying to figure out new ways to communicate with clients, provide their services and get information across to people. The nonprofit, founded by Ziegenhorn in 2016, provides services to people who use drugs, including naloxone distribution, overdose prevention education and connecting people with drug treatment programs. IHRC also focuses on policy development and grassroots advocacy.

The nonprofit is maintaining normal business hours and continuing to offer services during the pandemic at its Cedar Rapids office (1216 2nd Ave SE) and at its outreach locations in Iowa City, Des Moines and Dubuque, and by mailing materials.

Iowans have heard how important it is to stay at home and practice social distancing, and while these actions are necessary to prevent the spread of COVID-19, they can be particularly difficult and stressful for individuals with a substance use disorder.

Both Dr. Andrea Weber, a psychiatrist at the University of Iowa, and Ziegenhorn said the pandemic has affected their patients or clients in a number of ways.

“Substance use disorders are very isolating conditions, and people tend to be more successful in recovery when they feel like they have purpose, when they feel like they have meaningful work, when they feel like they have the ability to connect with other people who understand them and love them,” Weber said.

“These are not people who have traditionally done well being forced to stay in their home without access to that kind of support, and so I think that has been a significant issue with a lot of my patients,” Weber added.

Libraries closing, in-person counseling or group meetings being suspended, changes to transportation and legal proceedings being delayed are just some of the changes that can be difficult to cope with.

“When you take away a lot of abilities for them to use their other coping mechanisms, you’re kind of asking them just to really power through, and that’s extremely difficult,” Weber said. “It’s extremely difficult for all of us, let alone people who are trying to recover from substance use disorder.”

Ziegenhorn brought up how because people are socializing less, that also brings up the concern that if someone were to overdose, there might not be another person close by who can administer naloxone, a medication that reverses an opioid overdose.

“It’s just frankly unrealistic that all people will quit smoking during the pandemic or will quit drug use during the pandemic,” Ziegenhorn said.

“Many people have been predicting that because of the social and emotional and psychological distress that is tied to the pandemic, combined with people spending more time alone, could be a perfect storm for an increase in overdose fatalities,” Ziegenhorn added.

Weber works with the University of Iowa’s opioid addiction clinic, which she said has seen a surge in referrals since the start of the pandemic. The clinic provides medication-assisted treatment, which is a combination of medication, counseling and behavior therapies. The medications commonly used to treat opioid addiction are buprenorphine (often referred to by its brand name Suboxone) and methadone.

“I think for people that may have been considering treatment, there may have been … some concern that maybe the drug supply was going to change, that maybe they weren’t going to have access to their drug. In which case, they might be going through withdrawal or having to accommodate for that. There seemed to be a population that was kind of like, ‘OK, this is kind of the catalyst I needed.”’

The clinic, like other health providers, switched to phone appointments about a month ago and is in the process of transitioning to also offer video visits. Weber said the transition to telehealth could have also been a reason for the surge, since certain logistical barriers, like transportation, have been removed. There are still are some restrictions, Weber said, including the requirement that patients have a smartphone, access to the internet and an active MyChart account.

Previously, the Drug Enforcement Administration said that before a provider can prescribe medication to treat an opioid use disorder, there needs to be an in-person evaluation. That requirement was waived in March, allowing providers to do an evaluation on the phone or over video. (Weber said that while this has assisted in the prescribing of buprenorphine, a methadone prescription still requires a face-to-face appointment.)

The changes to telehealth during COVID-19 have been “very progressive,” Weber said. She would like to see them stay in place after the pandemic.

“I hope we don’t resort back to not reimbursing telehealth or telemedicine or making it so difficult for people to access care through that route,” Weber said. “I hope that a lot of these changes that were pushed through as a way to continue access to care — I hope people will actually see that there’s a lot of benefits to having this ability to do telemedicine for a lot of people for a service that maybe isn’t around in their area.”

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