Overdoses ‘accelerated’ during pandemic

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Southwest Washington has local representation on a recently-formed task force that is analyzing the impacts on mental health and substance use resulting from the COVID-19 pandemic.

The first roundtable meeting of the U.S. House Bipartisan Addiction and Mental Health Task Force took place virtually April 29, featuring national health officials and a slew of Congressional representatives. Among the task force’s leaders is U.S. Rep. Jaime Herrera Beutler, R-Battle Ground, who co-chairs the group announced in March.

Herrera Beutler and the other members of Congress convened remotely to ask questions and voice regional concerns regarding the pandemic and how it played into increases in substance use and overdose. 

Centers for Disease Control and Prevention Injury Center Deputy Director Chris Jones said although the pandemic took the forefront of medical crises in the past year, the drug overdose epidemic “preceded, persists, and indeed has been exacerbated by COVID-19.”

A CDC survey in June 2020 showed 13 percent of adults started or increased substance use as a means of coping during the pandemic, a rate higher than historic estimates that continued in a September followup. Jones was part of a study published in February using CDC data that found higher emergency department visits for overdoses, mental health conditions, and suicide attempts in 2020 compared to 2019.

Though drug overdose deaths were on the rise before the pandemic, Jones said the latest CDC data shows those deaths “only accelerated.” About 90,000 deaths were predicted in the 12 month period that ended in September 2020, accounting for “the highest number ever recorded in a 12-month period in the U.S.” The deaths were driven by synthetic opioids such as illicitly-produced fentanyl and stimulants like methamphetamine, he said.

Jones said the pandemic’s impact on individuals with substance use disorders is multi-faceted, and included a greater likelihood of more severe cases of COVID-19. He added social distancing policy and other efforts to stop the disease’s spread can increase feelings of isolation, which alongside economic and relationship stressors can worsen mental health and lead to increased substance use. 

The pandemic also impacted access to addiction treatment, overdose prevention, and recovery support services due to medical office closures, lack of in-person peer support groups and fear from those seeking care over potential exposure, Jones said.

National Institute on Drug Abuse Deputy Director Wilson Compton said in addition to more overdose deaths, drug testing data showed a greater use of a number of illicit drugs, with the combination of illicit fentanyl and other drugs rising “particularly significantly.”

Local challenges

Herrera Beutler said it isn’t difficult to understand how mental health declined during the pandemic. She said overdose deaths in Cowlitz County were estimated to increase by 43 percent year-over-year from 2019 to 2020.

“To me, that’s very scary,” Herrera Beutler said, adding the increase was greater than the 38 percent increase statewide, and fentanyl-related deaths doubled. 

She said the Drug Enforcement Agency’s 2020 National Drug Threat Assessment stated the Pacific Northwest was being “flooded” with synthetic opioids.

Herrera Beutler asked the national health experts how to get law enforcement, medical professionals and treatment centers on the same page to combat fentanyl-laced drugs, and care for people who already have a substance use disorder. 

Compton said it is important for law enforcement data to inform a public health response, explaining sometimes the earliest warning sign of an outbreak of fentanyl overdoses comes from seizures and drug busts.

“When they take a drug dealer out of circulation, that creates a vacuum in that local area where health care and health systems can help plug that gap by getting people into treatment during that time,” Compton said.

Herrera Beutler also asked about roadblocks rural communities face in regard to addiction treatment. Jones said there are a limited number of addiction specialists and psychiatrists in the U.S., with many based and focused in urban centers.

A solution could include a “hub and spoke” model Jones said began in Vermont that uses larger opioid treatment programs for initial stabilization and assessment. Subsequent treatment happens at “spokes” in the community, like primary care doctors, who manage individuals in the long run.

There are challenges to set up a similar system, which Jones said has been utilized in other health care settings in Washington, but not necessarily for addiction treatment. He said one of the reasons primary care doctors do not want to administer buprenorphine, a drug used in opioid addiction treatment, or other medications is because they do not feel like they have a “backstop.”

“If they run into trouble with a patient, who do they go to? Who do they bounce things off of?” Jones asked, explaining that having the connection to a specialist in the hub-and-spoke model provided that support. 

He added innovations in telehealth during the pandemic could enhance those kinds of models.

Treatment on the inside

Compton said his institute has a longstanding research priority to try to improve the intersection of the justice system and addiction treatment, recognizing those the institute is trying to help are often incarcerated. He said time in jail is an opportunity to intervene, both to help community impacts and the health of the individual when they re-enter the community.

Compton added the difference in treatment approaches inside and outside of corrections facilities can provide a hurdle for successful outcomes. Jones pointed to an approach in Rhode Island that provided medications to treat addictions for incarcerated individuals and a continuity of treatment upon a person’s re-entry. He said the approach led to a drop in overdose death rates both in formerly-incarcerated people and the population as a whole.

To help provide a more robust treatment for addiction to those who are incarcerated, task force co-chair Rep. Ann Kuster, D-New Hampshire, said she has been pushing to end an exclusion on Medicaid coverage for incarcerated people, saying it was a holdover from decades ago.

“There’s been inadequate mental health and substance use treatment for 50 years throughout our criminal justice system, and then we all act shocked when people come out and go back to their addiction,” Kuster said. “We’re not shocked when they go back to their diabetes, and we need to start thinking of it that way.”

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