As the COVID-19 pandemic approaches its peak, Ohioans suffering from opioid use disorder (OUD) face a crisis of their own. Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State, says that the opioid epidemic and COVID-19 pandemic have “crossed paths in a very lethal way.” Before the COVID-19 hit the U.S., approximately 3 million Americans were already suffering from OUD. In Cleveland, the opioid epidemic still haunts much of the city. Last year alone, there were 220 carfentanil deaths in Cuyahoga County—a ninefold increase from the 24 in 2018; some are calling the increase the “fourth wave” of the opioid epidemic.

Even as a fourth wave approaches, rehabilitation facilities have discontinued face-to-face counseling and support group meetings because of COVID-19. At Cleveland MetroHealth, meetings of one addiction support group have been suspended indefinitely due to social distancing. In place of weekly meetings, Dr. Rona Huckabee, an addiction therapist at Cleveland MetroHealth, still calls her attendees four times a week to check on them. However, she notes that a short phone call is not the same as a three-hour, in-person group session. With their support network mostly gone, patients must now cope with relatives who may not understand addiction, and the effects are beginning to show. 

One of her attendees struggles from heroin addiction and joined the support group a week before the suspension. “She says she is okay, but I know she’s not,” Huckabee tells the New York Times. 

The lack of in-person support has also left OUD recovery patients frustrated. “The pressure sucks right now. I’m just getting on my feet; I’m taking care of everything I need to take care of. And now I’m out of work,” Danny Pont, an OUD patient, tells Buzzfeed.

East of Metrohealth, University Hospitals (UH) has also changed the way they operate. At the Addiction Recovery Services in UH, routine outpatient addiction appointments now take place over telephone or telehealth. Telehealth visits include both video and audio. Some patients may still be required to come into the hospital to treat their severe withdrawal symptoms. These patients are part of a category of treatment called partial hospitalization. 

Despite efforts to readjust virtually, fears of being hacked loom over patients. Some have refrained from using telehealth appointments to avoid getting hacked or “Zoombombed.” USA Today found that addiction recovery patients have already been targets of Zoombombers, who taunted their condition. Others are afraid that hackers will compromise their privacy. 

COVID-19 regulations have also raised concerns for methadone clinics. These clinics distribute methadone, naltrexone and suboxone to OUD patients. At these clinics, the recipient must take their personalized dose in front of staff members. With social distancing regulations, clinics are also unable to operate as they usually do. 

Between the long lines and overcrowding, patients and healthcare workers at methadone clinics have expressed worry. Zachary Talbott is the president of the National Alliance for Medicated Assisted Recovery (NAMA). Talbott tells Becker Hospital Review that he has received reports from staff members of methadone clinics who have also voiced their concerns about the lack of social distancing in clinics. Talbott has received videos and photos of long lines of patients standing less than six feet apart. The overcrowding in methadone clinics is partially due to a long-term shortage. In Cleveland, for instance, there is only one methadone clinic, even though the city had been hit hard by the opioid epidemic.

The federal government has allowed doctors to prescribe buprenorphine, a medication used to treat OUD, virtually. The problem is that some insurers may not cover substance abuse telehealth. 

Syringe exchange programs seem to paint an equally bleak picture. Intravenous drug users often share needles when injecting opioids such as heroin or fentanyl. However, bloodborne pathogens such as HIV/AIDS and Hepatitis C often accompany non-sterile, shared needles. With syringe exchange programs (SEPs), staff can provide sterile needles to IV drug users and reduce the spread of HIV/AIDS. This strategy reduces the risk of contracting bloodborne pathogens from shared needles. 

Dr. Nora Volkow, director of the National Institute of Drug Abuse (NIDA), tells US News and World Report that SEPs around the country are “closing down or curbing services.” She tells US News and World Report that “many of these individuals are left with minimum support.” She says that this lack of support puts them at risk for homelessness and food insecurity.  

Dr. Andrea Milne is a SAGES teaching fellow at Case Western Reserve University and teaches a seminar on the history of AIDS. She says that these programs are a lifeline for intravenous drug users.    

Without these programs, drug users may revert to sharing unclean needles with each other. Needle-sharing requires drug users to be in close proximity, which she says would “violate social distancing guidelines.” As a result, she observes that the widespread closure of SEPs leaves patrons vulnerable to both bloodborne pathogens and coronavirus.

Aside from providing sterile needles, SEPs also have psychosocial support services for addiction, according to Milne. But when these programs close, support is harder than ever to find.   

Without treatment or access to clean needles, people with OUD may enter opioid withdrawal and may experience diarrhea, abdominal cramps and agitation. 

Patients living with OUD may also face respiratory problems, as opioids act by slowing down breathing, according to NIDA. The opposite is true for people suffering from respiratory disease. According to Milne, they are more likely to die from an overdose. If a patient with OUD contracts COVID-19, the NIDA says that they are more prone to respiratory symptoms of the virus. 

Milne emphasized, “I hasten to add that COVID-19 also threatens the sobriety of IV drug users in recovery, as Narcotics Anonymous and other group-based recovery programs are not as readily accessible as they used to be, especially for those who lack Internet access.”