How COVID-19 Is Affecting Those with Opioid Use Disorder

As the world remains battling the coronavirus pandemic, there are still significant and unmet needs for those fighting chronic conditions and disorders like opioid use disorder (OUD).

OUD is currently the number one cause of death in Americans under 50 and with the COVID-19 pandemic, the crisis is expected to worsen. For those battling addiction, quarantining and social distancing have resulted in disruptions of treatment and recovery services and limited access to mental health services and support patients so desperately need.

Sharon Walsh, Ph.D., director of the University of Kentucky Center on Drug and Alcohol Research, says COVID-19 has definitely presented some added challenges to the efforts to reduce the impact of the opioid epidemic. Kentucky, as well as other states, saw a sharp increase in overdose deaths back in the spring after widespread quarantine guidelines were put in place, Walsh says.

"While the media may be saturated with coverage of COVID-19 right now, the opioid epidemic is not forgotten – not by the researchers looking for better ways to prevent and treat addiction, not by the clinicians who worked quickly to transition to telehealth and retain patients in care, and certainly not by those who are living or struggling with this disease every day," she adds.

The pandemic is impacting those with opioid use disorder in many similar ways to how it is impacting everyone. Increased isolation, stress and anxiety are exacerbating symptoms for many of those who suffer from mental health disorders such, as depression, Walsh says.

However, that stress is an important trigger for relapse to drug use in those who are successfully abstaining. In addition, many recovery support services have historically been provided in group settings and there is reduced capacity for this due to social distancing. Loss of jobs and income may create challenges for individuals to seek or remain in treatment due to costs, she adds.

Another challenge toward this specific group is some of the organizations providing services to people with opioid use disorder have been hindered.

For example, syringe service programs provide critical harm reduction and health education. Many of the people who use these services aren’t in treatment, so it is a critical touch point for meeting people and helping to navigate them into evidence-based care. However, syringe services programs are often run by public health departments, and they’ve had to deploy their staffing and money to address COVID, which has taken priority away from the opioid crisis. They have been trying to figure out how to convert syringe services into a format that’s outdoors.

According to Michelle Lofwall, M.D., professor of behavioral science and psychiatry in the University of Kentucky College of Medicine, there is a need for medication options to treat OUD.

Medication treatment is incredibly important for patients to have access to, Lofwall says. It provides a clear reduction in risk for death and provides the opportunity for a successful remission from this disease so the person can have a meaningful recovery.

Opioid use disorder is a disease of the brain, not a lack of willpower, she says. It's about more than withdrawal. While withdrawal from opioids can be dreadful - physically and mentally – we know that stopping medication treatment after getting someone through withdrawal is not adequate treatment for most.

"Study after study shows the same results - that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after just a few weeks or a few months are very likely to relapse," Lofwall says. "And losing tolerance without ongoing medication treatment can result in a deadly overdose even after a single use – this is in part why opioid addiction is so fatal. A single slip to opioid use, particularly street heroin that often has highly potent fentanyl now, can be deadly."

Lofwall says there are three medications used to treat opioid use disorder: methadone, buprenorphine and naltrexone. Each medication works a little differently, but all act on mu-opioid receptors in the brain so cravings are reduced and the effects of illicitly used opioids are blunted when they are used; the euphoria and liking of the illicit used opioids as well as the respiratory depression are blocked. Thus, it is a waste money to use and one is less likely to stop breathing and overdose when on medication. Two of the medications, methadone and buprenorphine, also give patients relief from opioid withdrawal.

"Medication really gives patients a fighting chance to be driven less by cravings and withdrawal, to stay alive, and to make different decisions – to have more of their free will back – so that they are in a better position to work with their treatment provider to get into remission from opioid use disorder and their life back," she adds. "Medication is a necessary part of many people’s recovery, which is a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential."

For those affected with OUD, there are still services patients can access for their care.

The ability to offer telehealth appointments for opioid use disorder has been incredibly important this year, Lofwall says.

"Prior to COVID-19, we were not able to initiate outpatient buprenorphine treatment by telehealth as an outpatient practice, but the laws have changed during the pandemic," she says. "We are still offering in-person visits as well, under strict COVID protocols. There are some patients who still benefit from and need in person visits – whether it is because they need the in-person human interaction or there is a need for a physical exam that cannot be done via telemedicine, or they may not have access to the technology or Wi-Fi that allows for videoconferencing."

Some patients are doing well doing telehealth for consultations and group therapy remotely. Continuing to offer both options for patients is going to be critical for addiction treatment in the coming years, even while working toward getting COVID-19 under control.

As a physician, Lofwall has gotten more additional information from doing telemedicine due to seeing seeing patients in their own home environment or sometimes at their worksite. For example, you can see their living environment and sometimes hear from their family who cannot often come into the office, which gives insight about whether they may be struggling or thriving.

Walsh says the distribution of naloxone is another important element to reducing deaths from opioid use, and the more avenues used to get naloxone out in the community, the better.

"We need to think creatively about how to continue other support services during the pandemic to reach as many people as possible," Walsh adds. "As I mentioned before, syringe services are crucial for both harm reduction and health education, and we are working with organizations to find ways that we can offer these services safely, particularly through the winter when it becomes more difficult to keep everyone outdoors."