Support for those with opioid use disorders during the COVID-19 pandemic

Well, shit is admittedly pretty fucked up right now, eh? 

We don’t have answers for how to remedy this COVID-19 pandemic, but we do think it’s important to talk openly about the challenges we face. We know that, like many things, this COVID-19 pandemic is making it much more challenging for people living with addiction (and often co-existing mental illness) to make it through each day. When they’re faced with needing to obtain drugs or medication assisted treatment, they’re putting themselves and others in danger of contracting this highly transmissible, life-threatening virus that feels like something out of a movie. 

In collaboration with Dr. Nzinga Harrison, addiction specialist at Eleanor Health, Ben Miller at Well Being Trust, Garth Mullins of the Crackdown Podcast, Miss Ian Callaghan of the San Francisco Drug Users Unions, and several anonymous 12-step members, we wanted to share a few resources to help people with substance use disorders during such an unprecedented time. (Boston Medical Center’s Grayken Center for Addiction has reliable centralized resources, as well. Check ‘em out!)

IMPORTANT NOTE: If you are struggling with your mental health and/or physical safety, here are resources and places to call to get help immediately.

• The Challenge of Medication Assisted Treatment: As two addiction medicine and research physicians recently noted, “in case of quarantine, patients have been advised to ‘stock up’ on their medications, an option that isn’t available to those with prescriptions for controlled substances like methadone.” This restriction could lead to relapse and possible overdose during an already tenuous time. Put very simply by Garth Mullins, “You can’t quarantine if you’re dopesick.” 
  • Temporary Guidance for Dispensing Daily Medications through Opioid Treatment Programs (OTPs): Many people with opioid use disorder require daily medication—in clinics—to treat the illness. This is obviously a major obstacle during a quarantine. The Substance Abuse & Mental Health Services Administration is trying to make it easier for people to get their daily meds without all the hoops. Leaves us scratching our heads about why all the hoops were there in the first place, but that’s a question we tackle in excruciating detail on Last Day. 
  • In Canada, Garth Mullins and the Crackdown team have been advocating to ensure patients can access medication while socially distancing by prescribing take-home doses, relaxing rules about witnessed ingestion of opioids and opioid agonists (like methadone), and waiving requirements for doctor visits, therapy and urine screenings. 
  • In San Francisco, Miss Ian reports that “Methadone and Suboxone treatment centers are open. Our needle exchanges are all open, but hours and services have become limited. Which kind of looks like less drop-in hours, less groups, less hanging out.” We’ve got to find work-arounds to this as a community. MAT is one part of the puzzle. Support is another. 

• The Challenge of Missing Critical In-Person Meetings: Many treatment support programs, like Alcoholics Anonymous and Narcotics Anonymous, are built around daily in-person gatherings. Many people in recovery need these lifelines to maintain sobriety and balance in their lives. 
  • Temporary Guidance for Online Support Groups: Nearly all treatment support programs offer online options, and we should make this option universal to ensure consistency and community support during this trying time. Mental Health America has an online listing of how to find local support groups.  
  • AA Meetings Moving to an Online Model: AA Meetings across the globe have shifted temporarily to an online model, and people can easily find a time that works for them by going to https://www.aa-intergroup.org/directory.php. Updates about Coronavirus can be found at https://www.aa.org/pages/en_US/update-on-covid-19-coronavirus. 
  • There’s An App for That: The A.A. Big Book app is a handy resource, containing a copy of the book plus countless speaker meetings, stories, and a hotline to dial-in if you are in immediate need. There’s countless others as well. Dive in! You have the time. 

• The Challenges for Current Drug Users: At Last Day, one of our mantras is “Don’t use alone.” This is a primary principle of harm reduction, and something that legitimately saves lives. It’s also something that’s very complicated in a time of quarantine. Here’s some food for thought.
  • Go ahead and follow the Drug Policy Alliance: The DPA knows its stuff and is releasing daily recommendations related to policies and practices in a pandemic environment. These recommendations stand up in more “normal” times, as well.
  • While you’re at it, visit the Harm Reduction Coalition. There, you can search state by state for harm reduction programs and resources near you.
  • People who need to use drugs to avoid getting dopesick are still buying and using drugs. According to Miss Ian, “one of the things that protects homeless people from overdosing is the fact that they hang in groups. And cops have been breaking up people hanging in groups because that’s what they’ve been ordered to do during this ‘shelter in place.’ Because of this, people who are using on the street are more often doing it alone, or not being monitored closely by their peers because they’ve been made to separate. So since this started there has been a slow increase in overdose fatalities it looks like. We’re currently trying to figure out good ways to combat this problem.”
  • Check out Crackdown’s coverage of the impact of COVID-19 on substance users: https://crackdownpod.com/podcast/episode-14-emergency-measures/ It’s thourough, informative, nuanced and extremely well done. 
  • Law enforcement should immediately stand down on all drug law enforcement for the duration of the COVID-19 pandemic. According to Garth Mullins, “People currently held on drug charges and non-violent offenses should be released immediately. Social distancing is almost impossible in jails and prisons and people often aren’t given access to basic hygiene and sanitary items.”
  • Now, more than ever, harm reduction must be a priority: Provide a safe supply of drugs for current drug users plus access to life-saving harm reduction tools such as fentanyl test strips and naloxone.  

• The Challenges of Added Stress During an Unprecedented Time: For many, the uncertainty of this pandemic is devastating—reduced hours, reduced pay, job loss, loss of childcare. These stressors can make recovering opioid users especially vulnerable for relapse. 
  • Temporary Guidance for Managing Stress: Use any and all networks you have for support…while practicing social distancing. For example, identify someone to call if you’re feeling especially anxious. Though we are practicing social distancing to prevent the spread of this pandemic, that doesn’t mean you can’t go outside for walks, hikes, breaks, etc. There are also various online therapy programs that offer financial aid, and you can talk to real therapists from your home, over text, over video chat, and so on.
  • Immediately reduce homelessness in the US and abroad. Garth Mullins is advocating for the Canadian government to house everybody immediately to slow the spread of COVID-19. Governors and mayors should do the same in the U.S. Unoccupied housing and hotel rooms should be made available to vulnerable people and families around the world.
  • Measures that can be taken by the government:
    • Declare an immediate moratorium on eviction and rents; halting all mortgage defaults and foreclosures.  
    • Legislate paid sick leave for all workers, including paid leave for all workers who are quarantined or self-isolating.  
    • Cancel student debt for all. 
    • Give every person an immediate basic income payment, increase income assistance and disability to a living wage
    • Universal healthcare. 

• The Challenge of Losing Healthcare: Most Americans still receive their health insurance coverage through their employer, and in a crisis like this, where business is slow and many are unable to show up for work, many will end up losing their jobs or being laid off. Considering less than half of folks who make between $40-90k a year are able to work from home, there’s a high likelihood that many will lose their jobs AND their health coverage, which will ultimately make it hard to afford treatment.
  • Temporary Guidance for Finding Alternate Options for Coverage: Depending on several factors, there are a few options out there to find additional coverage to help pay for mental health and addiction treatment (e.g., through the marketplace, temporary coverage through COBRA, and Medicaid). As with any plan, you’ll just need to make sure that the benefits are sufficient for your treatment—be sure to ask exactly what’s covered, at what level, and how much will it cost you out-of-pocket for care.
  • Make It Easier for the Consumer to Access Essential Medications: The federal government should consider pharmaceutical drugs for physical and mental health—including for substance use disorder—universally free at the point of service during this crisis.

As we continue this fight against the opioid crisis and the COVID-19 pandemic, we hope local, state, and federal governments and healthcare facilities identify and implement critical measures to save lives and manage the opioid epidemic. In writing this piece, we talked with Ben Miller who works to help the world understand social isolation, loneliness and deaths of despair (suicide, overdose, etc.) in “normal” times.  “When recommendations are to create social distance, and in some cases self-quarantine, if we are not also paying attention to how we can provide support and address loneliness and isolation, we are adding a problem on top of a problem,” Ben shared. 

We agree. At a time like this, it seems like “one day at a time” is truly our best option. In a recent episode of Last Day, one of our guests compared this concept to driving a car: “You can’t drive looking too far up the road, or you’ll crash. Looking in the rearview mirror, you’ll crash. You gotta look right in front of you—right now. And that’s kind of how I do my life. Just one day at a time, not looking too far ahead or too far back unless it’s for a purpose.” 

We think we could all take this advice to heart at a time like this. 
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