While many physicians are focused on healing patients and preparing for a COVID-19 vaccine in the next few weeks, we cannot neglect another important aspect of our nation’s health: helping individuals overcome the opioid crisis.
“In my clinic I’ve seen the full spectrum of responses to COVID-19,” Anna Lembke, MD, Associate Professor of Psychiatry and Behavioral Sciences and Chief of Addiction Medicine Dual Diagnosis Clinic at Stanford University School of Medicine told the Los Angeles Tribune.
Opioid use has increased during the pandemic in over 40 states, and those with opioid use disorder are at higher risk for catching the coronavirus. While over 260 thousand Americans have died from the coronavirus, tens of thousands of Americans also die of opioid overdose.
“Sadly, I’ve had patients who have overdosed and died from their opioid addiction due to increased isolation, a disruption in their access to peer and professional recovery resources, and the uninterrupted flow of fentanyl and other opioids,” Dr. Lembke said, “but I also have patients for whom the pandemic and sheltering in place has reduced their triggers, making it more possible for them to enter and/or sustain recovery.”
Dr. Lembke was one of the first in the medical community to sound the alarm regarding opioid overprescribing and the opioid epidemic. In 2016, she published her best-selling book on the
prescription drug epidemic, Drug Dealer, MD – How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop (Johns Hopkins University Press, 2016). Her book was highlighted in the New York Times as one of the top five books to read to understand the opioid epidemic (Zuger, 2018).
Similar stories of opioid drug overdose and death can be found from coast to coast. “Any life lost to the opioid epidemic is a tragedy,” Abdelkader Mallouk, MD, a New York based Family Physician who also specializes in addiction medicine told the Los Angeles Tribune.
The Coronavirus pandemic increases opioid misuse
The New York Times called the COVID-19 pandemic a “national relapse trigger.” The Los Angeles Tribune says the stressors of the pandemic can cause increased substance misuse. Social distancing, unemployment and economic instability all may trigger anxiety, depression and cause an increase in opioid dependence.
Those with opioid use disorder are more susceptible to COVID-19
COVID-19 attacks the lungs and causes respiratory problems. Due to this very fact, the virus could have potential implications for people with opioid use disorder.
“COVID-19 is an atypical viral infection, primarily involving the lungs in a multi-focal distribution, often in both the right and left lung,” Ejaz Shamim, MD, Assistant Professor of Radiology and Director of the Diagnostic Radiology Residency Program at the University of Illinois at Chicago said. “Typically, there are ground-glass opacities of varying degrees of consolidation, indicating sites of infection and pulmonary edema.”
According to a study by the National Institute of Health, those with substance use disorder (SUD) are more likely to get coronavirus and specifically, those with opioid use disorder. This is because opioid use disorder can compromise the lungs and cardiovascular system making them weaker by slowing down the brain cells which in turn results in slower respiration. This lack of oxygenation to the brain makes irreversible damage more likely.
Additionally, those with a SUD are more likely to experience certain challenges such as homelessness or incarceration and these circumstances ultimately facilitate transmission of the virus. Therefore, people with opioid use disorder must be treated like any other high-risk group during the pandemic.
The second wave of the pandemic may worsen the opioid epidemic
During the second wave of COVID-19, several states have instituted new measures of isolation including restricted travel, decreased gathering sizes and closing public places like restaurants and businesses. These increased measures will add significant challenges to those with opioid use disorder and so the medical field needs to be prepared to treat those struggling with substance abuse during the pandemic’s second wave.
“One of the responses to the pandemic has been to make therapeutic opioids for addiction and pain more readily available. At the same time, patients are more isolated and we’re less able to conduct the monitoring to guard against diversion. The result may paradoxically be an increased risk of opioid overdose.” Dr. Lembke stated.
Medically assisted treatment can help
Opioid treatment programs are critically important and should remain open during the pandemic. Offering a physical location for individuals with opioid use disorder to detox in an accredited hospital is an essential component of any successful program.
“Opioid withdrawal is extremely painful for some individuals, and drives them to re-use, even when their goal is to get off. In some rare instances, opioid withdrawal can be life threatening. Therefore, it’s essential that people struggling with severe opioid withdrawal have access to medically monitored detoxification in a hospital or other accredited detoxification setting,” Dr. Lembke added. “Just like a person having a heart attack should not be excluded from hospital admission due to COVID-19, so too should people in the throes of severe opioid withdrawal have access to high acuity inpatient care.”
In her new book, Dopamine Nation: Finding Balance in the Age of Indulgence, set to be released in 2021, Dr. Lembke gives solid advice on how to strike the balance between pleasure and pain as they relate to all sorts of addictions. Readers can hope to find evidence-based solutions through the lived experiences of her patients.
We must act now
“If we do not act soon the progress made in recent years to fighting the opioid epidemic may all be reversed by COVID-19,” Dr. Mallouk said. “Additionally, the second wave of the pandemic will significantly worsen the effects of opioid use disorder in America.”
If you or someone you know is affected by the opioid epidemic, seek medical help from a professional as soon as possible. Additionally, if someone has symptoms such as vomiting, stopped breathing, slowed heart rate or limp body, you should call 911 immediately. As we refocus on improving our health after COVID-19, we must also reemphasize our response to opioid dependence.
By: Adam Eid Ramsey, MD, Alt-Resident Representative to the Board of Directors at the NY State Academy of Family Physicians and Board Member of the Operations Commission as well as the Diversity, Equity and Inclusion Taskforce.