To our country still reeling from its ongoing opioid epidemic came the COVID-19 pandemic. The public health crises in the U.S. this time did not come one after the other but overlapped. One health crisis is already one too many. 

These twin battles need to be fought at the same time. It is possible with technology. And neither severity nor urgency will win the argument for which crisis should be a priority—because both are claiming lives. 

COVID-19 has disrupted practically all of society’s functionality. The domino effect of a beleaguered healthcare system is far-reaching. It has not spared the substance abuse disorder patient community, either those who are recovering or those who still need saving.

All areas of healthcare have rapidly adapted to the temporary normal: a restricted care setting where physical distancing, home quarantine, and isolation are the new imperatives for containment. And enforced in hospitals and health centers are strong infection prevention and control protocols. The COVID-19 pandemic poses a unique challenge in that all these had to be done in rapid-fire speed and providers have to work at a furious pace, beyond normal capacity.

Substance use disorder treatment also had to comply, as there are considerations in place for crisis centers and clinicians to manage the treatment of alcohol or benzodiazepine withdrawal during the COVID-19 pandemic. Guidelines for outpatient and inpatient services have been set by the Substance Abuse and Mental Health Services Administration (SAMHSA) to include the use of telemedicine for an initial visit between a patient and doctor employing medication-assisted treatment. 

Flattening the Curve

Efforts to flatten the curve of the opioid epidemic also need to be sustained. As urgent as the need to reduce person-to-person proximity amid the spread of the coronavirus is the uninterrupted treatment for opioid addiction. For either and for both, we are in a race against time to save lives.

Spectrum Health Systems knows so well that with or without the pandemic their patients need medications every single day. “This treatment saves lives, so we’ve got to keep finding ways to push through this pandemic,” said Kristin Nolan, vice president of behavioral health for Spectrum.

As part of emergency plans for their inpatient addiction treatment locations, Spectrum has trained nurses to know the difference between possible symptoms of COVID-19 and symptoms of withdrawal. 

To prescreen patients for the coronavirus prior to a consultation, or to treat them for either condition or both, is another challenge that is compounding addiction treatment...as if the loss of physical connection that is forced on patients due to social distancing is not bad enough for patients in recovery.

Deploying Telehealth Solutions

To fight these twin battles here and now takes an army of capable healthcare providers in tandem with tech solutions. To meet the physical-distancing challenge created by the pandemic for people with addictions and their care providers, innovative solutions need to be deployed.

Automating remote communication for telehealth treatment for substance abuse may now be more critical than ever. According to PBS health news, COVID-19 has “prompted the medical community to turn to telehealth as a way to provide more comprehensive opioid addiction care, particularly during the time of social distancing.” 

As addiction is a disease of isolation, Amy Leone, owner of a community mental health counseling practice in Milford, Massachusetts, believes that people with addiction are all the more at risk. 

According to an article published in The Hill, for those people who use drugs or are in treatment for an opioid use disorder, the risk of overdose is more immediate than the threat posed by COVID-19. A disruption in harm reduction or effective treatment services can also result in painful drug withdrawal or the risk of HIV, viral hepatitis, or abscesses.

For those still grappling with their recovery, “the forced isolation sparked by the coronavirus pandemic is a nightmare scenario” that some treatment experts fear could lead to a public health crisis. The same News Day special report cited addiction expert Jeffrey Reynolds, who referred to the coronavirus as a  “perfect storm” for the recovery community.

Roy Kearse, vice president of a Queens-based drug treatment center, was quoted saying that during this crisis, those detoxing from drugs may fall through the cracks. Relapse among them is probable and feared.

He added that social distancing may translate to social isolation for substance use disorder patients and “they may not be able to come into centers but we want them to know there is a lifeline for them.” 

In this time when group therapies, in-person counseling, and medication-assisted treatments have to contend with the physical restrictions put in place due to COVID-19, a tech strategy to patient care will help ease the overburdened healthcare system. 

Virtual care programs, originally designed to make treatment accessible in remote places or to address doctor shortages, have now been fitted to care settings for substance use disorder, as part of the COVID-19 control measure. This has occurred as the Drug Enforcement Administration (DEA) relaxed the rules for telemedicine to treat a substance use disorder.

The use of telemedicine through such means as communication platforms providing videoconferencing, texting, and mobile-app messaging to aid in the recovery from opioid abuse is not new. Even more innovative is a patient engagement platform that is not an app and utilizes any device, communicating in any way that the patient chooses to communicate with providers, either on an automated or remote basis.

The above-mentioned PBS report cited that even before COVID-19, experts saw how telehealth could reduce the stigma surrounding opioid addiction. “Because of COVID-19, many states are issuing emergency declarations to help pave the way for launching telehealth services at a faster rate,” PBS News Hour added. 
 

Accessing Care During A Pandemic
 

Telehealth plays a critical role in providing access to care. And in a coronavirus crisis, it’s patient safety too.  Dr. Bradley Buchheit, the medical director for OHSU's HRBR Care Clinic said that the timing is more important than ever before. 

“it’s really important now so that we can support our public health colleagues and try to prevent the spread of the novel coronavirus while also providing high levels of evidence-based treatment for addiction,” he added.

Politico in a newsletter explained that telehealth seems to be one of the key legs supporting the pandemic response, “as the medical system aims to keep patients well-cared-for but also out of the hospital.” 

And likewise, telehealth can go a long way in keeping the opioid epidemic in check.

There have been strides in battling the opioid crisis, and COVID-19 should not deter that progress. Instead, use the expanded telehealth options that this pandemic has opened up to push for a seismic shift in the delivery of behavioral health.