Covid has changed our lives. Lockdowns, self-isolation, canceled events, and mask-wearing….could anyone have imagined this last Columbus day?
Everyone is under stress. Some notably more than others. But perhaps those who have been destabilized the most are the ones who struggle with addiction disorders. Experts are predicting a record year for opioid-related overdosages, surpassing lasts years tally of 72, 000.
This is not surprising when nonprofit groups, such as HIPS, report losing a lot of patients. Not just because of COVID or drug-related deaths, but also from disruptions in health care, public transport, and financial stressors. Other studies highlight the disproportionately large increases in substance use in areas with more poverty and residents belonging to a racial or ethnic minority, the same populations burdened with a higher incidence of COVID.
But an additional problem has been highlighted – the failure to deliver effective treatment for opioid use disorder, even among patients requiring emergency treatment and even in those facilities that offer substantial addiction specialty treatment services. In one study, only 10% of patients were offered medications for opioid use disorder, and only 56% received a prescription for naloxone. Although 68% received information or a referral, previous studies have shown this approach is ineffective, with withdrawal and craving symptoms usually leading to a quick return to illicit drug use if no actual treatment is offered.
But some aspects of care have improved. The emergency expansion of Medicaid reduced financial barriers to treatment and naloxone for many. There was also an easing of the restrictions for methadone dispensing and an expanded role of telemedicine in patient care. There has been a definite correlation with access to medication for opioid-use disorder and increased treatment engagement and hospitalization reductions. But ultimately the success of these policies comes down to state, clinic, and clinician implementation and overcoming any structural barriers that hinder access to proven treatments.
One thing that might be up for reconsideration is fully-funded medical-grade heroin prescribing schemes. These are available and successful in countries such as Canada, Germany, and Switzerland, and recently, two 29 week pilot schemes in the UK were so successful that they have been extended for another year. The UK schemes reported a 99% reduction in illicit heroin use, a 329% improvement in the psychological health of the participants, plus a 99% reduction in the number of crimes committed by these individuals, and were funded from money seized from criminal gangs.
Because almost everyone agrees that prison, increased sentencing, and police crackdowns do nothing to break the cycle of drug addiction. And anything to reduce our widening health disparity must be worth a try.