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mariebenz · 2 years

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Geisinger Study: Methadone ‘take-homes’ during COVID-19 Resulted in Greater Methadone Overdoses

MedicalResearch.com Interview with:

Dr. Piper Brian Piper, PhD MS Assistant Professor of Neuroscience Center for Pharmacy Innovation & Outcomes Geisinger School of Graduate Education MedicalResearch.com: What is the background for this study? Response: Methadone is an evidence-based treatment of opioid use disorder (OUD) and pain. However, this Schedule II opioid can also cause respiratory depression, which can result in lethality. The need for supervised administration is a long-standing source of frustration in the U.S. for many opioid use disorder (OUD) methadone patients. However, there was an accommodation in early 2020 thanks to the COVID-19 pandemic. This involved extending the take-home supply to up to 28-days for stable patients and 14 days for less stable patients. Prior research found that the implementation of supervised administration in England greatly reduced methadone overdoses . The primary objective of this study from Geisinger Commonwealth School of Medicine was to determine if the relaxation of the take-home rules resulted in more methadone overdoses.

MedicalResearch.com: What are the main findings? Response: Overdoses involving methadone from 1999 to 2020 were analyzed using data from the CDC’s WONDER database (Figure, left panel). There was a 48% increase from 2019 to 2020. Overdoses in 2020 were also significantly elevated relative to 2000–2003 and 2018 but significantly lower than 2006–2008. Among the top ten states for overdoses in 2020 (Rhode Island, Washington DC, Delaware, Connecticut, New Mexico, West Virginia, New York, Maine, Illinois, and Massachusetts), nine were located in the eastern US. New England states were also well represented. The association between methadone overdoses and methadone distribution as reported by the Drug Enforcement Administration was also evaluated. The state level correlations between overall methadone use (r(49) = +0.75, p < .001), and opioid treatment program use (r(49) = +0.77, p < .001) with overdoses were positive, strong, and statistically significant (center panel). However, methadone use for pain treatment was not associated with methadone overdoses (r(49) = −0.08, right panel). MedicalResearch.com: What should readers take away from your report? Response: Accommodations for the COVID-19 pandemic were both well-intentioned and necessary. However, great caution should be made before making them permanent. There is value in supervised administration, particularly for OUD patients early in recovery, regular urine-analysis, and in-person counseling. We are concerned about turning our backs on past lessons in how to maximize the safety of methadone for OUD treatment . These findings also contribute to a larger evidence base that methadone can be safely used for pain including cancer pain. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Death determination is made by both medical examiners and coroners and is not a simple process . Further research on methadone involved overdoses should be completed by states with the resources to run the analytical chemistry including for other substances (e.g. xylazine) that may contribute to lethality. This study did not determine how many of the decedents were prescribed methadone versus how many purchased diverted methadone. As other reports indicate that there were 300K methadone patients and over 3,000 methadone overdoses in a single year (i.e. 1 overdose per 1,000 patients or 0.1% per year for a drug that many patients receive for multiple years), this topic should warrant further empirical attention. MedicalResearch.com: Is there anything else you would like to add? Response: Methadone, when combined with counseling, is an evidence-based treatment for opioid use disorder. Because methadone retains patients in treatment better than buprenorphine , it will continue to be an important component of biopsychosocial treatments for OUD. Citations - Strang J, et al. Impact of supervision of methadone consumption on deaths related to methadone overdose (1993-2008): Analyses using OD4 index in England and Scotland, BMJ 341 (2010) c4851. - Kaufman et al. Examination of methadone involved overdoses during the COVID-19 pandemic. Forensic Science International 2023; 344:11579. https://authors.elsevier.com/a/1gXPQ1MCG0a4Rc - Peppin et al. What your death certificate says about you may be wrong: A narrative review on CDC's efforts to quantify prescription opioid overdose deaths. Cureus 2021; 13(9):e18012. - Mattick et al. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2008; 2:CD002207, Read the full article

#OUD #@GeisingerHealth #@medresearchnews #@RELXHQ #COVID-19 #methadone #opioids

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topsailaddictions · 2 years

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What Is Drug Rehabilitation and How to Use It

The process of receiving medical or psychotherapeutic treatment for addiction to psychoactive substances like alcohol, prescription drugs, and street drugs like cannabis, cocaine, heroin, or amphetamines is known as drug rehabilitation. The overall goal is to empower the patient to defy substance dependence, if present, and stop substance abuse to avoid the mental, legal, monetary, social, and actual consequences that can be caused.

Psychological dependency is addressed in manydrug rehabilitation programmes by attempting to teach the person new ways of interacting in a drug-free environment. Treatment also includes medication for depression or other disorders, expert counseling, and sharing experiences with other addicts. Patients in particular are usually told, or maybe even required, not to hang out with peers who continue to use the addictive drug. Addicts are encouraged not only to stop using alcohol or other drugs but also to examine and alter their addiction-related behaviours through 12-step programs. Recovery, according to many programs, is a process that never ends. In the case of legal substances like alcohol, complete abstinence is also emphasised rather than moderation attempts, which may result in relapse ("One is too many, and a thousand is never enough").

"Whether those with a history of substance abuse can maintain moderation" remains a contentious issue. Addictive substances alter the chemical structure of the brain, and these changes persist long after an individual stops using them. Types Various programmes offer assistance in drug rehabilitation, including residential treatment (in-patient or out-patient), local support groups, extended care centers, recovery or sober houses, addiction counseling, mental health care, and medical care. This change in brain structure increases the risk of relapse, making treatment an essential component of the process. Types In an American survey of treatment providers from three distinct institutions (the National Association of Alcoholism and Drug Abuse Counselors, Rational Recovery Systems, and the Society of Psychologists in Addictive Behaviors), the Spiritual Belief Scale (a scale measuring belief in the four spiritual characteristics of Alcoholics Anonymous identified by Ernest Kurtz) was used to measure the treatment providers' responses. [citation needed] In addition, medically assisted drug detoxification or alcohol detoxification alone is ineffective as a treatment for addiction. The National Institute on Drug Abuse (NIDA) recommends detoxification followed by both medication (where applicable) and behavioural therapy, followed by relapse prevention. The scores were found to explain 41% of the variance in the treatment provider's responses on the Addiction Belief Scale, which is a scale measuring adherence to the disease model or the free-will model of addiction. The National Institute on Drug Abuse (NIDA) says that in order for a treatment to be successful, it must include both medical and mental health services, as well as follow-up options like community- or family-based recovery support systems. Regardless of the method used, patient motivation is a big part of the success of the treatment. [citation needed] Treatments for people who are addicted to drugs that affect the same brain systems tend to be similar to those for people who are addicted to drugs that affect different brain systems. Addiction to prescription opiates can be treated with medications like methadone and buprenorphine, and addiction to prescription stimulants, benzodiazepines, and other drugs can be treated with behavioural therapies.

For More Info: Rehab Massachusetts

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evokewellnessmasite-blog · 4 years

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Knowledge What Goes On In A Drug Rehabilitation Center

Do you have a drug dependancy dilemma and planning of likely to a drug rehab? It can be scarring especially when you do not know what to anticipate. In this article is what you should hope. Levels of Drug Rehab Most drug rehab packages are divided into 4 phases: intake, growth of a remedy program, cure, and continuing stage. Intake: this is the assessment procedure that happens when you pay a visit to the rehab middle for the initial time. Throughout intake the procedure qualified will request you a range of issues that are aimed at knowledge your drug use historical past. The healthcare professionals will also want to fully grasp your spouse and children record. Should you loved this article and you would want to receive details relating to massachusetts heroin detox kindly visit the site. You will have to fill a lot of sorts which include the therapy consent type that outlines the confidentiality plan of the system. Progress of the treatment strategy: the medical professional will come up with a treatment prepare that is guided by the information and facts that you give throughout the intake phase. The health practitioner will focus on the plan with you and if you have any concern you are totally free to handle it. Therapy: this is where genuine cure commences. A person of the most critical sections of the therapy is cleansing wherever the medical practitioners try to do away with all the medication from your entire body. Continuing care: this is aimed at assisting you to simply return to your "normal" daily life. If you have enrolled oneself in a excellent rehabilitation middle, you will be specified a "sponsor." This is a particular person who has properly abstained from prescription drugs and is thoroughly clean. What Occurs For the duration of Detox? As mentioned higher than, the detoxification method is 1 of the most significant processes in a drug rehabilitation center consequently, you have to have to have a very good knowledge of it. The principal goal of this approach is to help you eradicate actual physical withdrawal symptoms. The procedure usually takes concerning 3 and seven days and it truly is done underneath the supervision of a capable medical doctor. To relive anxiousness and avert seizures, the physician may perhaps prescribe some prescription drugs such as methadone or buprenorphine. Once you have efficiently undergone the detoxing process, you can now commence addressing the social, psychological, and psychological issues that are linked to your addiction. Summary This is what you should really count on in a drug rehabilitation middle. For ideal final results you should be cautious when selecting a center. To select the appropriate center you should really take into account a variety of things this kind of as: courses available in the center, charge of remedy, degree of household involvement in the programs, and availability of the continuing care method.

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waynemacfaddenmd · 5 years

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MAT Offered Through Telehealth by New Start-Up

A Psychiatrist and Addiction Specialist at the Spirit Lake Indian Nation Tribal Health Center in North Dakota, Wayne Macfadden, MD, performs psychiatric evaluation and treatment of Native Americans. In addition to that, Wayne Macfadden, MD, treats substance use disorders with medication-assisted treatment (MAT). Bicycle Health, a new start-up company based in Boston, Massachusetts, is providing MAT to patients via telemedicine. This step away from brick-and-mortar MAT improves patient access to such services, since it maintains their discretion when seeking MAT in a judgement-free setting. The innovative MAT program from Bicycle Health starts with a 90-minute appointment with a health care provider. This appointment is done in person and is necessary for physicians to assess the mental health, substance abuse history, and physical health of the patient so they can create a suitable MAT program. Patients are usually not required to meet with a physician again after completing this assessment appointment. Based on the diagnosis physicians make following their meeting with patients, they may prescribe naloxone or buprenorphine, along with a personalized treatment strategy. After one week, the physician calls to check on their progress. Online chats are subsequently completed with the patient every other day, and telehealth visits are set up with the patient every week during the first month of treatment. This decreases to telehealth visits every two weeks for two months, then visits every month until the program is completed. Meanwhile, patients can get their prescription either at a local pharmacy or delivered to their home to further increase confidentiality.

#telehealth #telemedicine

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addictionfreedom · 6 years

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Addiction Treatment Center Of New England

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addictionrecoveryassistance · 6 years

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Detox Centers In Midland Oregon 97634

Contents

635 main street

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Placing dialysis professionals

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therecoversite · 6 years

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Only 30% of Overdose Victims are exposed to Medications to Treat Addiction

New Post has been published on https://www.therecover.com/only-30-of-overdose-victims-are-exposed-to-medications-to-treat-addiction/

Only 30% of Overdose Victims are exposed to Medications to Treat Addiction

A new study shows only 3 out of every 10 non-fatal drug overdose victims are followed up with access to medications to treat opioid addiction. A disappointing result to an upsetting consistent medical emergency facing thousands of Americans every day, the conclusion shows the lack of follow through within an overburdened medical system.

The study took place in Massachusetts, one of the states hit hardest in the nation, between 2012 and 2014 on over 17,000 patients who overdosed on opioids that were treated by ambulance or an emergency department. Of those 17, 658 overdose victims, only 3,022 were given buprenorphine (brand name Suboxone) and 2,040 victims were given methadone.

Medication Assisted Treatment’s proven good was no exception in this case, and the results showed the Suboxone group had a 40% lower death rate after one year compared to those who never received medication following an overdose. Methadone proved stronger, with a 60% lower death rate after one year. The opiate blocking medication Naltrexone (known as Vivitrol) had lower results of only 6% of patients had positive results, but those patients only took the medication for one month. Vivitrols’ patients were no more likely to be alive than those that were given or offered a medication.

The good news is, we have proven effective treatments out there and when made available and accepted by struggling addicts, they show higher success rates than most recovered persons without any assistance. But only 3 out of 10 overdose victims are getting that chance to recover.

Most people who visit an emergency room for a life threatening medical event leave with some sort of medication or follow up directions by physicians. They are told how to manage their condition to avoid a repeat of their episode and follow through with further medical advice from their family doctor. Even after a heart attack you get an aspirin. So why is it acceptable to leave an addict, who’s condition is scientifically proven to be a brain disease, up to their own devices after a near fatal health crisis?

These low rates of follow through are rooted deep in stigma, and short treatment courses emphasize the need for intervention during the time of overdose. But it’s not always emergency medical facilities fault.

“Treatment facilities often lack medical personnel who can prescribe medications; even if staff at opioid treatment programs are able to dispense methadone, they may not be waivered to prescribe buprenorphine. In addition, insurers may not cover all forms of medication-assisted treatment, and when they do, coverage is usually subjected to limits on duration that lessen treatment effectiveness.” The studies’ publishers say.

“A great part of the tragedy of this opioid crisis is that, unlike in previous crises American has seen, we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments,” the authors wrote.

With the news of a generic Suboxone being approved early last week by the FDA, hopes of reaching more users can become an affordable reality. Steps like these can help ensure available resources are back within reach of people who may have not had a chance to have access to the life changing medications before. When paired with psychological treatment, an addict has its best chance at recovery.

Source : The Recover Newsroom

#Featured #Uncategorized

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lodelss · 4 years

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ACLU: As Overdoses Spike During Coronavirus, Treating Addiction in Prisons and Jails is a Matter of Life and Death

As Overdoses Spike During Coronavirus, Treating Addiction in Prisons and Jails is a Matter of Life and Death

As the Coronavirus pandemic continues to sweep through the country, especially in prisons and jails, the opioid epidemic has also seen a resurgence. The Washington Post reported that suspected overdoses jumped nationally by 18 percent in March, 29 percent in April, and 42 percent in May. This fits a nationwide pattern of excess deaths — deaths above the typical number anticipated by the CDC — unrelated to Coronavirus, such as the increased toll from heart attacks, strokes, and cancer, all as our medical infrastructure is pushed to its limits. There has never been a more critical time to provide medication for addiction treatment (MAT) for people with opioid use disorder (OUD). MAT consists of three FDA approved medications — methadone, buprenorphine, and naltrexone — that treat OUD, the disease at the root of opioid addiction. MAT is basic healthcare and a cornerstone of care for tens of thousands of people in our communities who have OUD. The need for MAT is particularly strong in jails and prisons: Without access to their medication, recently incarcerated people are left with few tools to battle their addiction. If provided with MAT, they are 74 percent less likely than people who are deprived of MAT to die of any cause while they are still incarcerated, and 85 percent less likely than people who are deprived of MAT to die of an overdose in the weeks after their release. Yet in the face of these stark numbers, 98 percent of jails and prisons still deny this lifesaving treatment to incarcerated people. The small but growing number of prisons and jails that have implemented programs to provide MAT to incarcerated people with OUD have seen success. One study of the Rhode Island prison system, which was among the first to implement a robust MAT program, found that providing MAT reduced post-release deaths by 60 percent, and all opioid related deaths in the entire state by 12 percent. Sheriff Chris Donelan in Franklin County, MA reported a reduction in recidivism, overdose deaths, disciplinary concerns, and contraband after providing access to MAT. In addition to saving lives, courts have found that providing MAT is a constitutional and civil right for incarcerated people. The Eighth Amendment to the U.S. Constitution bans “cruel and unusual punishment,” which the Supreme Court has interpreted as prohibiting “deliberate indifference to serious medical needs.” Further, the Americans with Disabilities Act (ADA) prohibits discrimination in public services, such as health care in jails, based upon a recognized disability, like OUD. Last year, the First Circuit affirmed a ruling in the District of Maine under the ADA that a jail could not deny a woman serving a 40-day sentence access to the MAT prescribed to her by a doctor. This followed a decision by the District of Massachusetts that required a jail to provide an incarcerated individual with his prescribed MAT dose throughout his time in custody, holding that the denial of his medically necessary MAT was likely cruel and unusual punishment in violation of the Eighth Amendment as well as unlawful disability discrimination under the ADA. As of July 22, more than 100,000 incarcerated people have been infected with COVID-19 and more than 760 have died. Even in the best of times, incarcerated people often receive substandard medical care, or no care at all. As COVID-19 cases make a resurgence in parts of the U.S. and continue to dramatically spike in jails, prisons, and detention facilities across the country, it has never been more important to provide evidence-based care for people with opioid use disorder in order to conserve hospital resources and save lives. Our prisons and jails aren’t designed to be drug rehab centers, and we must stop using them as such. Keeping people out of jail in the first place by making sure that they have reliable access to MAT both inside jails and prisons, and when they are out in the community, will help stop the rampant spread of COVID-19 and reduce the burden on our medical system. Further, as researchers have pointed out, the symptoms of opioid withdrawal and COVID-19 can overlap. Without access to MAT for OUD, there is an increased danger that prison officials will miss suspected cases of COVID-19, assuming that the symptoms exhibited are a result of opioid withdrawal, when in fact they are symptoms of COVID-19. This creates a danger that a positive COVID-19 case could be missed by a correctional facility, allowing a positive individual to spread the disease to others with whom they share close quarters. The answer to this problem should never be solitary confinement. Denying incarcerated people access to MAT adds a strain on the American health care system, even in the best of times. Nearly one quarter of America’s prison and jail population of 2.2 million have OUD. During this crisis, it is even more imperative that people with OUD get access to the MAT they need. Instead of letting unlawful and scientifically unsound jail policies fill our hospital beds with people experiencing post-release overdoses, let’s provide MAT to incarcerated people and use our hospitals to fight the COVID-19 crisis at hand. We’ve already seen the federal government take some positive steps once thought impossible. This includes letting MAT patients take home their buprenorphine for twenty-eight days in order to limit social contact while maintaining MAT treatment. While the federal Bureau of Prisons (BOP) has taken steps to expand access to MAT, the Department of Justice has supported recommendations from the Government Accountability Office aimed at making BOP improve the implementation of its MAT program so that it can serve everyone in need. It is time for Congress and state legislatures around the country to follow the lead of states like Rhode Island, and require MAT in all jails and prisons for everyone it is clinically appropriate for.

Published July 23, 2020 at 02:06AM via ACLU https://ift.tt/3hsIC33 from Blogger https://ift.tt/39mgtrO via IFTTT

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nancydhooper · 4 years

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As Overdoses Spike During Coronavirus, Treating Addiction in Prisons and Jails is a Matter of Life and Death

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jesseneufeld · 4 years

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A tale of two epidemics: When COVID-19 and opioid addiction collide

I am a primary care doctor who has recovered from — and who treats — opiate addiction. I work in an inner-city primary care clinic in Chelsea, Massachusetts, which currently has the highest rate of COVID-19 in the state, due, in part, to poverty. These two experiences offer me a clear view of how these two epidemics — COVID-19 and opioid addiction — can impact and worsen each other. Two great epidemics of our generation are intersecting in ways that are additively deadly, and which highlight the urgent ways we must respond to some of the underlying fault lines in our society that are worsening both crises.

Social determinants of health create greater vulnerability

People who suffer from the disease of addiction are particularly vulnerable to both catching the coronavirus and having a more severe disease when they do catch it. There are many reasons for this, but they boil down to something called social determinants of health, which according to the CDC are “conditions in the places where people live, learn, work, and play [which] affect a wide range of health risks and outcomes.” In short, people suffering from addiction are vastly more vulnerable to coronavirus, as they are more likely to be homeless, poor, smokers with lung or cardiovascular disease, under- or uninsured, or have experienced serious health and socioeconomic issues from drug addiction. There are also millions of vulnerable incarcerated people, many of whom are stuck in jail due to their addictions and related nonviolent drug offenses.

Treatments and support systems may be disrupted

For someone struggling with addiction, virtually all of the services and treatments available to them have been disrupted by the COVID-19 epidemic. People are told to stay home, which directly contradicts the need to go to clinics to obtain methadone or other medications for treating addiction. Our government, in response, has relaxed regulations so that, in theory, clinics can give 14-day or even 28-day supplies to “stable” patients, so that they don’t have to wait in line and can adhere to social distancing for safety. Unfortunately, there are countless stories of patients not being granted this privilege, including at least one of my own patients.

Similarly, the government has relaxed some restrictions on buprenorphine prescribing, and has allowed some telephone prescribing, but this presupposes that there are doctors available that are healthy and certified to prescribe this medication, and that the pharmacies and doctors’ offices are functioning. Access to clean needles is affected as well. Additionally, may rehab facilities have limited new admissions, cancelled programs, or even shuttered their doors for fear of spreading coronavirus in a communal living setting.

Social isolation increases the risk for addiction

A common truism in recovery culture is that “addiction is a disease of isolation,” so it stands to reason that social distancing — in every possible way — is counter to most efforts to engage in a recovery community. It is important to remember that experts distinguish between physical distancing and social distancing, and actually emphasize that we keep physical distance, but make extra efforts to maintain social bonds during this time of enormous stress and dislocation.

The social isolation that is so critical to preventing the spread of coronavirus prevents people from attending peer-support groups, which are such a vital source of emotional and spiritual support to people struggling to stay in recovery.

Isolation may increase the risk of overdose deaths

Heightened anxiety is a near-universal trigger for drug use, and it is difficult to think of a more stressful event — for all of us — than this pandemic. Users who adopted harm reduction techniques and had been using drugs with a friend are now using them alone, and there is no one nearby who could administer naloxone or call 911 in the event of an overdose. As a consequence, police have been finding people dead in their apartments. When people do call 911, the health care system is overloaded, and first responders may arrive more slowly. We know that starting addiction treatment in the ED can help prevent relapse, but right now emergency room doctors are absolutely overwhelmed with COVID-19 cases, and might not have the time or resources available to start addiction medications following an overdose.

Sadly, the ugly face of stigma and discrimination is coming out as well, as there are reports surfacing of police departments across the country that are refusing to offer naloxone to patients who have overdosed, on the pretext that it is too dangerous because the “addict” might wake up coughing and sneezing coronavirus droplets.

Multiple health crises mean comprehensive solutions

What we need to do now is reach out more than ever to those who are struggling with addiction, and provide them with the resources, such as online meetings, so that they are not alone and forgotten during this dual crisis of coronavirus and addiction. We need to make sure that they are getting the medications they need to recover, that they have access to clean needles if they are still using, adequate medical care, food, and housing — basic human needs.

If any good has come out of the misery of the combined COVID-19 and opioid epidemics, perhaps it is that a clear, bright light has been shined on the deadly social fissures — poverty, income inequality, lack of health insurance and access to healthcare, homelessness — that are the true social determinants of health we will need to address as part of an effective response to future pandemics.

The post A tale of two epidemics: When COVID-19 and opioid addiction collide appeared first on Harvard Health Blog.

A tale of two epidemics: When COVID-19 and opioid addiction collide published first on https://drugaddictionsrehab.tumblr.com/

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mhealthb007 · 4 years

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Social determinants of health create greater vulnerability

Treatments and support systems may be disrupted

Social isolation increases the risk for addiction

Isolation may increase the risk of overdose deaths

Multiple health crises mean comprehensive solutions

The post A tale of two epidemics: When COVID-19 and opioid addiction collide appeared first on Harvard Health Blog.

from Harvard Health Blog https://ift.tt/2Kmldlu Original Content By : https://ift.tt/1UayBFY

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gordonwilliamsweb · 5 years

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Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

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Before the coronavirus became a pandemic, Emma went to an Alcoholics Anonymous meeting every week in the Boston area and to another support group at her methadone clinic. She said she felt safe, secure and never judged.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

This story can be republished for free (details).

“No one is thinking, ‘Oh, my God. She did that?’” said Emma, “’cause they’ve been there.”

Now, with AA and other 12-step groups moving online, and the methadone clinic shifting to phone meetings and appointments, Emma said she is feeling more isolated. (KHN is not using her last name because she still uses illegal drugs sometimes.) Emma said the coronavirus may make it harder to stay in recovery.

“Maybe I’m old fashioned,” said Emma, “but the whole point of going to a meeting is to be around people and be social and feel connected, and I’d be totally missing that if I did it online.”

While it’s safer to stay home to avoid getting and spreading COVID-19, addiction specialists acknowledge Emma’s concern: Doing so may increase feelings of depression and anxiety among people in recovery — and those are underlying causes of drug and alcohol use and addiction.

“We consider addiction a disease of isolation,” said Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

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Emma has another frustration: If the methadone clinic isn’t allowing gatherings, why is she still required to show up daily and wait in line for her dose of the pink liquid medication?

The answer is in tangled rules for methadone dispensing. The federal government has loosened them during the pandemic — so that patients don’t all have to make a daily trip to the methadone clinic, even if they are sick. But patients say clinics have been slow to adopt the new rules.

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, said he issued guidelines to members late last week about how to operate during pandemics. He recommended that clinics stop collecting urine samples to test for drug use. Many patients can now get a 14- to 28-day supply of their addiction treatment medication so they can make fewer trips to methadone or buprenorphine clinics.

“But there has to be caution about giving significant take-home medication to patients who are clinically unstable or actively still using other drugs,” Parrino said, “because that could lead to more problems.”

The new rules have a downside for clinics: Programs will lose money during the pandemic as fewer patients make daily visits, although Medicare and some other providers are adjusting reimbursements based on the new stay-at-home guidelines.

And for active drug users, being alone when taking high levels of opioids increases the risk of a fatal overdose.

These are just some of the challenges that emerge as the public health crisis of addiction collides with the global pandemic of COVID-19. Doctors worry deaths will escalate unless people struggling with excessive drug and alcohol use and those in recovery — as well as addiction treatment programs — quickly change the way they do business.

But treatment options are becoming even scarcer during the pandemic.

“It’s shutting down everything,” said John, a homeless man who’s wandering the streets of Boston while he waits for a detox bed. (KHN is not including his last name because he still buys illegal drugs.) “Detoxes are closing their doors and halfway houses,” he said. “It’s really affecting people getting help.”

Adding to the scarcity of treatment options: Some inpatient and outpatient programs are not accepting new patients because they aren’t yet prepared to operate under the physical distancing rules. In many residential treatment facilities, bedrooms and bathrooms for patients are shared, and most daily activities happen in groups — those are all settings that would increase the risk of transmitting the novel coronavirus.

“If somebody were to become symptomatic or were to spread within a unit, it would have a significant impact,” said Lisa Blanchard, vice president of clinical services at Spectrum Health Systems. Spectrum runs two detox and residential treatment programs in Massachusetts. Its facilities and programs are all still accepting patients.

Seppala said inpatient programs at Hazelden Betty Ford are open, but with new precautions. All patients, staff and visitors have their temperature checked daily and are monitored for other COVID-19 symptoms. Intensive outpatient programs will run on virtual platforms online for the immediate future. Some insurers cover online and telehealth addiction treatment, but not all do.

Seppala worried that all the disruptions — canceled meetings, the search for new support networks and fear of the coronavirus — will be dangerous for people in recovery.

“That can really drive people to an elevated level of anxiety,” he said, “and anxiety certainly can result in relapse.”

Doctors say some people with a history of drug and alcohol use may be more susceptible to COVID-19 because they are more likely to have weak immune systems and have existing infections such as hepatitis C or HIV.

“They also have very high rates of nicotine addiction and smoking, and high rates of chronic lung disease,” said Dr. Peter Friedmann, president of the Massachusetts Society of Addiction Medicine. “Those [are] things we’ve seen in the outbreak in China [that] put folks at higher risk for more severe respiratory complications of this virus.”

Counselors and street outreach workers are redoubling their efforts to explain the pandemic and all the related dangers to people living on the streets. Kristin Doneski, who runs One Stop, a needle exchange and outreach program in Gloucester, Massachusetts, worried it won’t be clear when some drug users have COVID-19.

“When folks are in withdrawal, a lot of those symptoms can kind of mask some of the COVID-19 stuff,” said Doneski. “So people might not be taking some of their [symptoms seriously], because they think it’s just withdrawal and they’ve experienced it before.”

Doneski is concerned that doctors and nurses evaluating drug users will also mistake a case of COVID-19 for withdrawal.

During the coronavirus pandemic, needle exchange programs are changing their procedures; some have stopped allowing people to gather inside for services, safety supplies, food and support.

There’s also a lot of fear about how quickly the coronavirus could spread through communities of drug users who’ve lost their homes.

“It’s scary to see how this will pan out,” said Meredith Cunniff, a nurse from Quincy, Massachusetts, who is in recovery for an opioid use disorder. “How do you wash your hands and practice social distancing if you’re living in a tent?”

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk published first on https://nootropicspowdersupplier.tumblr.com/

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stephenmccull · 5 years