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People Seeking Drug Treatment Weren't Ready for the PandemicHere's what We Learned About Relapse and Recovery
But Percocet was different. The highly addictive prescription painkiller belongs to a class of drugs known as opioids, and is often prescribed to people dealing with chronic pain. Her then-boyfriend, who introduced Brown to the drug, was addicted to Percocet. Brown soon became addicted to the drug too, and with the couple abusing the same expensive drugone that can cost as much as $25 per pill without insurance, and $10 per pill on the streettheir habit became pricey.
To keep up with their addiction, the pair began looking for alternatives to Percocet that would give them a similar high at a lower price point. That's how they found street drugs laced with fentanyl, a dangerous (and often deadly) synthetic opioid far more potent than both heroin and morphine. According to the Centers for Disease Control and Prevention (CDC), fentanyl is so strong that it's normally only prescribed to treat severe paintypically that of advanced- stage cancer patients. Unfortunately, this transition is common: When doctors refuse to refill an opioid addict's prescription, the addict will often take to the streets for an easier, cheaper highone that fentanyl-laced substances provide.
Prior to the COVID-19 pandemic, America was gripped by an epidemic of opioid use resulting in a troubling rise in overdoses caused in part by the introduction of fentanyl to the country's illegal drug supply. 2010 saw 38,329 drug overdose deaths, according to the National Institute on Drug Abuse. Nine years later, that number rose to 70,630, per the CDC.
Though it's been less discussed, the COVID-19 pandemic has also likely led to a rise in relapse rates for those in recovery from drug abuse. Official data on this rise doesn't exist yet and likely won't for another six months to a year, Neeraj Gandotra, MD, the chief medical officer at the Substance Abuse and Mental ishonest Services Administration (SAMHSA), tells ishonest.
But anecdotally, experts in the drug abuse and recovery fields say they've witnessed a surge in relapses during the pandemic. Lindsey Staymates, a former supervisor at Foundations, tells ishonest she specifically saw "some spikes in relapses" even among patients who had been sober for five years. Timothy Brennan, MD, director of the Addiction Institute at Mount Sinai West and the Mount Sinai Morningside Hospitals in New York City, said the pandemic had an effect on his patients as well: "People have a foundation in recovery. When that foundation has been shaken it's really scary. I do think we've seen a lot of relapses."
Though a lot of fields benefitted from the increased use of telemedicine during the pandemic, people in treatment for substance use disorders were more likely to suffer.
For those in recovery, in-person 12-step or support groups are essential to their success. But the shutdown of these vital services due to the COVID-19 pandemic was listed as a primary concern among the survey participants. Survey respondents specifically commented on this issue, noting that they had "no ability to socialize/connect or to get peer support." Others shared that "meetings have all been reduced to Zoom and it has had an impact on feeling supported by peers and getting a good recovery message," and that "doing online meetings [is] not the same as going to a meeting."
Staymates, who worked directly with Brown on her recovery, also says this was among the most difficult challenges the COVID-19 pandemic presented to treatment facilities. "We were unable to see clients face to face. That caused a huge breach in the closeness with clients [that is] necessary to developing a relationship with them," she explains.
For Brown, those disruptions in care and lack of in-person meetings were hugely detrimental. "I was able to get a sponsor, but I only met her once in person," Brown says. And Zoom therapy sessionsmeant to provide some face-to-face contact were often distracting. "You're Zoomingbut you're doing your laundry. It's just a bunch of strangers on a computer screen," she says. "People will send you phone numbers and stuff, but you're not getting that connection. I didn't call them. Not one."
For those in outpatient therapymeaning they stayed at home rather than inside a treatment facilityrecovery in a pandemic posed additional challenges. While those in inpatient therapy were often provided with internet access for online counseling (which didn't necessarily work the way in-person counseling does), people in outpatient therapy didn't always have that option. Even if internet access was available, some patients in recovery live in places without steady service or WiFi. "Their only phone may be a landline [instead of] a smartphone," Vakharia says. That's a big deal, since some treatment providers only get compensated for audiovisual appointments, not phone calls, making them more likely to provide audiovisual appointments only, she adds.
While therapy sessionsone-on-one or in group settingswere for many addicts a casualty of the pandemic, so was access to medications to help stave off a relapse. Methadone and buprenorphine are two FDA-approved drugs given to patients to treat opioid use disorder. The meds are administered in small quantities, normally at clinics, where patients can go each day to receive their dose.
When the pandemic hit, the SAMHSA loosened those guidelines, allowing patients to take home 14 to 28 days of methadone at a time. But Vakharia says this effort looked better on paper than in practicethe loosening was simply a guideline to follow, not a mandate. That meant methadone clinics could simply choose to overlook the suggestion and continue operating as usual, forcing many patients to either risk catching COVID-19 or choose to socially distance and thus forego their necessary medication.
Even when methadone clinics followed the SAMHSA guidelines, those in recovery met another challenge in obtaining their medication: cost. "A lot of people have to pay out-of-pocket cash copays for methadone," Vakharia says. That means people have to shell out for 2-4 weeks of doses at once. Just one week of methadone treatment can cost $126, according to the National Institute on Drug Abuse, putting the option out of reach for many of those who need itespecially when buying multiple weeks of the medication at once.
In addition to considering these behavioral services as essential care, the pandemic has also brought to light some inefficiencies in how former addicts are able to receive treatment, even when it's available to them. COVID-19 has shown that the process of obtaining methadone and buprenorphine is stricter than it needs to be, experts believe. "The sky doesn't fall when you loosen restrictions," Vakharia says. Making naloxone more readily available may also help, she adds. Naloxone (commonly known by its brand name Narcan) is an FDA- approved medication that can reverse the effects of an overdose, but it can be difficult to access when prescribed due to high copays or decreased chances of getting life insurance after a prescription, she explains.
Luckily, she says her second try at recovery has been easier, especially due to loosening restrictions from COVID-19. "We have softball on Sundays. We get coffee again," Brown says, adding that she feels different than before. "There's no significant epiphanies I'm going to have, but there's a program that can help me not feel guilty, not feel ashamed. I'm a lot more invested now."