It was the epidemic before the pandemic.
With the novel coronavirus continuing its spread, Minneapolis-area drug and addiction experts say they fear that overdose rates will skyrocket as people become more isolated and the country’s public health system nears capacity.
“We can expect to see more overdoses and more overdose deaths,” said Hennepin County opioid response coordinator Julie Bauch. “We do not expect to see fentanyl and other heroin analogues going anywhere.”
She worries that addiction rates will go up with COVID-19 shuttering entire industries and putting millions of Americans out of work, even as officials enact social control measures to keep people at home and slow the spread of the virus.
According to police statistics, the number of drug-related deaths in Minneapolis through April 19 is roughly the same as the same time last year. But, overall overdose calls have gone up roughly 8%, to 437 from 404 in 2019, which ended the year with 1,499 suspected overdoses — the highest levels in at least the past dozen years.
Bauch, a nurse by training, suspects those numbers will only go up in the coming months. Some people dealing with substance abuse are being turned away from hospitals and clinics already suffering from a shortage of beds in the wake of the coronavirus outbreak, while others are avoiding medical settings altogether out of fear of getting infected, she said.
“There are some barriers to care for individuals who have a substance abuse disorder, and one of them is we can expect to see staffing shortages in clinics and hospitals, and we can expect the emergency department will become more unpredictable in being able to treat them,” Bauch said, adding: “Treatment programs that are either inpatient or require group setting, are either closing for new admissions or putting pause on new admissions or are requiring strict restrictions.
Dr. Brian Grahan said that he expects more people will seek out “warm fuzzy” opioid highs to escape feelings of isolation and financial stress from lost jobs.
“So that’s the best feeling to have right now, when there’s so much uncertainty and anxiety, people just want to feel wrapped up,” said Grahan, an addiction-medicine physician at HCMC. “But interestingly you don’t see that much of an increase in meth and cocaine (use) because it doesn’t really help that feeling.”
At the same time, he said, people in recovery rely on human contact, which is tricky under social distancing rules.
In the weeks since the stay at home order began, therapists and doctors are finding ways to work with patients who aren’t in the same room, while federal health officials have loosened restrictions on telemedicine to make it easier for healthcare professionals to offer anti-addiction medication such as buprenorphine and methadone remotely.
Support groups like Alcoholics Anonymous have started conducting meetings by phone or video conferencing. Even the Hazelden Betty Ford Foundation has turned to online services, offering clients 12 hours of weekly drug and alcohol recovery group therapy in the seven states where it has locations.
Local health officials are saying that parts of Minneapolis are now feeling the full brunt of the opioid epidemic that ravaged parts of New England and Appalachia for much of the past decade. While methamphetamine and cocaine use have risen, opiates like heroin still account for most drug deaths in the city, officials say.
In recent weeks, authorities have noticed a steady increase in intravenous heroin use, raising the risk of disease outbreaks. Authorities have also seen a rise in calls for overdoses of drugs like PCP and LSD, which can induce vivid hallucinations.
And even before the crisis, a growing number of kratom-related overdoses. The powdered herbal extract has been growing in popularity as an alternative to opioids, but authorities warn it can have dangerous side effects.
Lorena Pinto, vice president of programs at The Family Partnership, a Minneapolis nonprofit, said that as fewer drug outreach workers visit the hardest-hit communities, “we could actually be looking at increased deaths.”
Most substance abusers are already on shaky ground, Pinto says, with many facing the overlapping issues of mental health and homelessness that are only likely to grow as the pandemic spreads.
“We have to come up with better solutions that are still humane for everybody,” she said. “And stuffing people into shelters and increasing high capacity is not safe — they will turn to the streets, because for them that does feel safe.”
Researchers have recently begun studying the relationship between economic hardship and substance abuse.
A 2017 study by economists from Indiana University and the University of Virginia concluded that opioid death rates rose faster in countries where the unemployment rate jumped unexpectedly.
Another study of people who received buprenorphine to treat opioid use during and after Hurricane Sandy found that few reported increased substance use, “despite many disruptions to regular” supplies of the widely used anti-addiction medication. “Offering patients with a backup location to provide refills, medical, and psychiatric treatment ensured minimal disruption to continuity of care,” the report’s authors wrote.
Grahan, the HCMC doctor, said that it’s too soon to say how addiction rates will be affected by the COVID-19 crisis, which he says is unlike any natural disaster or, even, the financial crisis of 2008.
But, he added, researchers have found that stressful times can trigger relapses in drug users, who see themselves losing control of their lives.
“The psychosocial consequences of the treatment for COVID are exacerbating a lot of other health issues,” said Grahan, pointing to research that says substance abuse is often preceded by mental health issues. “For people in recovery it’s really hard to stay out in situations like this, when you don’t have a really hard support network.”
Stephanie Devich, a harm reduction specialist at Valhalla Place, a treatment center in Brooklyn Park, said that the uncertain times will attract a new generation of drug users.
“The younger, naive user doesn’t know things that keep us safer,” said Devich.