The Pandemic Has Changed Addiction Treatment, Some Hope For Good

When the coronavirus pandemic hit, 51-year-old Gigi Geary decided to move from Boston to stay with family in a remote area of New Hampshire. She's particularly at risk because she's undergoing cancer treatments, so she wanted to isolate herself as much as possible.

Moving to New Hampshire also meant being far away from her addiction treatment providers at Boston Medical Center, but Geary says she hasn't lost touch with them.

"They tell you we can call them 24 hours a day, and I'll tell you, anytime I've called them and needed them, they've been right there," Geary says.

Geary has been at a patient at Boston Medical Center's Office Based Addiction Treatment Program (OBAT) for more than a decade. Before March, she was going in every other week to meet with a clinician and get her prescription for bupenorphine, a medication that helps prevent opioid withdrawal symptoms. Now, Geary checks in weekly. She recently called and a nurse set up a virtual meeting.

"I was really depressed last week, and me and her did a FaceTime, and it was just amazing," Geary says. "I felt so much better after."

Like other health care providers, Boston Medical Center transitioned to telemedicine for most patients when the pandemic hit. That was also when the state ordered insurance to cover virtual visits the same as in-person visits.

They tell you we can call them 24 hours a day, and I'll tell you, anytime I've called them and needed them, they've been right there.

Gigi Geary

BMC's OBAT team scrambled to get ready, setting up a hotline, giving phones to patients and programming in clinicians' numbers. The team also provided phones to all the clinicians and reached out to people who might need their services, such as those released from correctional settings and those accessing needle exchange programs, to let them know that addiction treatment was still available.

"Patients, when they need treatment, get super anxious," says Colleen LaBelle, director of the OBAT program. "If they can't reach somebody and can't access it, bad things can happen."

The OBAT program used to take patient calls from 7 a.m. to 10 p.m., but LaBelle wanted someone available around the clock, because she expected the pandemic would create confusion. At first, that meant giving out her own cell phone number.

"We're in the middle of this emergent situation and didn't have a whole lot of time to put things in place," LaBelle says. "So I utilized my contact information for the off hours, so at least I could talk to that person, make that connection and then get them what they needed."

Since March, LaBelle says the number of weekly patient visits in the program has doubled to about 400, and many patients tell her they find telehealth more convenient. She says more of her patients now show up for their appointments.

Overall, Labelle believes the changes prompted by the pandemic have helped addiction treatment. In addition to telehealth, those changes include allowing treatment programs to create COVID-19 units, and permitting easier access to addiction medications like buprenorphine, without an in-person visit first.

"We've basically started to treat substance use disorder like other diseases and normalize it somewhat," Labelle says. "I hope this pandemic helps us look at substance use like any other disease."

Changes on the federal level prompted by the pandemic allow more patients to get doses of methadone to take at home, rather than going to a clinic each day for the medication. About two-thirds of the more than 23,000 people in Massachusetts prescribed methadone are now allowed to take it at home for up to 28 days at a time. State health officials say since the pandemic began, there have been only 19 reports of lost or stolen methadone.

"Nineteen is just amazing," says Deidre Calvert, director of the the Bureau of Substance Addiction Services for the Department of Public Health. "And we've had zero reports of overdose deaths due to methadone."

That data will be used to help determine if some of the changes to addiction treatment will continue after the pandemic. Calvert hopes many of them do, but she acknowledges that right now some patients aren't getting any treatment at all.

I hope this pandemic helps us look at substance use like any other disease.

Colleen Labelle

New state data on opioid overdoses is expected to be released next week, but those numbers will reflect what happened until April. Calvert expects a clearer picture of how the pandemic affected overdoses to emerge when the next numbers are released, six months from now.

"At beginning of the pandemic, we were hearing that people were hunkering in and not accessing treatment, but we were also not hearing as many stories of overdoses," Calvert says. "But now we are starting to hear, anecdotally, of what we were hearing before the pandemic. And we'll see what the numbers support when they come out in the fall."

Some reports suggest that many patients are opting not to seek residential treatment. Calvert says some programs initially stopped taking patients because of concerns about the virus, so DPH worked with them to come up with plans to create separate coronavirus units.

But some providers say it appears that patients may be wary of going to residential programs where the virus might easily spread. Some inpatient treatment providers report they have about 50% fewer patients than they had pre-pandemic. And the number of civil commitments to addiction treatment through the courts is down by more than 50%.

"We know people are isolating, and we're worried about people using not just opioids, but all kinds of substances," Calvert says. "Recovery doesn’t happen alone, it happens in a community."

Addiction specialists also say social distancing measures can conflict with a strategy known as harm reduction, where the goal is to keep patients safe if they're still using drugs. Those patients are often advised not to use alone, so someone can call for help in the case of an overdose. Now, some providers are advising patients to use drugs only with the same group of people and urging them not to share needles.

"Some patients are not ready to stop using although ideally that's what we want," says Dr. Carolina Abuelo, a primary care physician at Massachusetts General Hospital's Charlestown Health Care Center. "So we tell them if they're going to use, use as safely as possible. "

With being locked in the house all the time you get stir crazy. As an addict, you know that that's your last reserve — to go and get drugs. That's not where I'm at anymore. I just wish that people would go and get the help that they need.

Gigi Geary

Abuelo recently lost two patients to overdoses. One man was using drugs alone and was not able to take the overdose reversal drug naloxone, or Narcan, that she had prescribed.

"I think he died because he was socially isolating and probably using alone," She said. "Had he been with friends or family they might have given him Narcan, and he might have been found."

Abuelo believes that many of the changes made because of the pandemic have helped addiction treatment, but she says their positive effects could be outweighed by the challenges — such as doctors not being able to see patients in person and drug test them if needed.

"In general I think in this pandemic we’re going to see that things have gotten worse," Abuelo says. "Either with overdoses or complications from substance use disorder like more infections. Coping mechanisms might not be strong to start with, and then you have somebody calling you and offering you an easy out, a bit of oblivion, you might get weaker and take that opportunity to forget your problems for a few minutes."

Geary hopes that people don't allow the pandemic to trigger temptation.

"With being locked in the house all the time you get stir crazy. As an addict, you know that that's your last reserve — to go and get drugs. That's not where I'm at anymore," Geary says. " I just wish that people would go and get the help that they need."

Under the coronavirus reopening plan outlined by Gov. Charlie Baker this week, hospitals and health care centers can start seeing some patients in-person. Among the first allowed back will be those with substance use disorders.