For Dan Caplin with Colorado Addiction Treatment Services, treating people addicted to opioids is complicated to say the least.
“This is so multifactorial,” he said, before listing about 10 local and national systems that can either help or inhibit the treatment process.
The nation’s efforts to address opioid addiction, however, haven’t escaped the impacts of the coronavirus pandemic, according to some health professionals and preliminary data.
Widespread mitigation efforts to limit the coronavirus’ spread coincided with increases in opioid-related overdose deaths across the state and country. Health providers are noticing that patients are facing heightened risk factors for heavy drug use tied to isolation and joblessness.
It’s still too soon to fully understand how the pandemic might be affecting issues related to opioid misuse. But health professionals are keeping a keen eye on concerning early reports.
“What my patients are reporting to me is a very high increase in overdose deaths,” said Caplin, who directs the Durango-based treatment center. “I had two patients, each lost four friends over the holidays from overdoses. I’ve had plenty of patients who’ve lost 10 friends in 10 years. Four in a week is devastating.”
In mid-December, the Centers for Disease Control and Prevention sent out an alert to health professionals warning of substantial increases in drug overdose deaths across the United States.
The increase was primarily driven by rapid increases in overdose deaths involving synthetic opioids, likely involving the powerful synthetic opioid fentanyl.
The largest increase was recorded between March and May 2020, when communities around the nation were shutting down to try to prevent the coronavirus’ spread, the alert said.
The Colorado Department of Public Health and Environment also showed an increase in opioid-related overdose deaths.
Between March and September 2020, 581 Coloradans died from opioid overdoses, according to Kirk Bol, CDPHE vital statistics branch chief.
That is an 82% increase compared with an average of 320 deaths in similar periods in 2017 through 2019. Comparable data for Southwest Colorado was not available Wednesday.
“Despite the fact that COVID-19 has overtaken national consciousness, it doesn’t mean the opioid epidemic has gone away,” said Kate Hartzell, executive director of the Southwest Colorado Area Health Education Center. “It continues to be this underlying national issue.”
Health data quickly gets complicated. It would need to be analyzed and “scrubbed” to present a clearer final picture, said Caplin, Hartzell and Stephanie Allred, senior clinical director with Axis Health System.
“I think the biggest message here is: One opioid overdose death is too many,” Hartzell said.
Fentanyl is a factor that is just as concerning as the pandemic is to health professionals. Pills aren’t always what they appear to be, Caplin said.
“One tablet might have no fentanyl, and the other might have enough to kill multiple people. They all look alike,” he said. “It’s truly Russian roulette with what’s going on out there.”
If people are using alone, and if they do overdose, there’s less opportunity for rescue, Allred said.
“In terms of the trends that we’re seeing, it’s just not surprising with the extra challenges that our community members are facing,” Allred said.
Stress, anxiety, isolation, joblessness, lack of peer support, lack of in-person health care visits – all are risk factors for excessive drug use. All have become heightened for patients during the pandemic, Caplin said.
“We’ve had a number of our formerly stable patients also relapse, and they’re really struggling to get back on track,” Caplin said.
But health care providers are still working to reach people in need.
Axis has shifted group therapy to a virtual format to offer services to patients while limiting possible viral spread at in-person gatherings.
Colorado Addiction Treatment Services is gearing up to open a satellite clinic in Cortez to reach more people.
In Colorado, many services are free for patients on Medicaid, which removes a financial barrier to access. Private insurance companies don’t always cover addiction treatment. Fortunately, the country’s pandemic response relaxed some Medicaid rules which can be helpful to patients, Caplin said.
Agencies in La Plata County are working to educate residents about opioid use, reduce stigma associated with addiction and distribute Narcan and a naloxone, which are used to reverse opioid overdoses.
“Anybody can become addicted to opioids,” Hartzell said. “We have this feeling that substance use happens to certain kinds of people. If you want a picture of an opioid addict, look around you.”
For those who might know someone with opioid-use disorder, Allred said the key is to stay in contact with them.
“It’s important to communicate that we care and are thinking about each other,” she said.