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Most people know by now that older adults and people of any age with serious underlying health conditions like heart disease or diabetes are most at risk for severe illness from COVID-19. Among lesser known populations at risk for poor outcomes from COVID-19 are people with Opioid Use Disorder (OUD), according to the National Institute on Drug Abuse.

The more obvious reasons for this vulnerability are health-related. Opioids and other misused substances can impact one’s physical health by compromising heart, respiratory, and pulmonary systems. Social distancing can be stressful and isolating for anyone, and it can exacerbate existing mental health conditions such as depression or anxiety (which are often comorbidities with OUD). For people with OUD, social distancing can also cause disruptions in treatment and separate them from peers, organizations, and groups that they rely on for treatment and recovery support.

“We will likely see an increase in overdose deaths related to COVID-19. The pandemic is negatively affecting individuals with opioid use disorder, their families, and the behavioral health system. These impacts could remain long after social distancing stops,” Jennifer Reynolds, MPH, CHES, section manager for Health Communication, Marketing and Training at ORAU. Reynolds co-authored Communicating About Opioids in Appalachia: Challenges, Opportunities and Best Practices, and is leading the ORAU team working with four university partners on the National Institutes of Health’s HEALing Communities Study.

Because of the need for social distancing to protect everyone from COVID-19 infection, many jails across the country are releasing non-violent offenders and some treatment programs have suspended both in-patient and outpatient treatment. While rapidly releasing non-violent offenders is a great strategy to prevent thousands from contracting coronavirus, it poses challenges for preventing overdoses.

“Typically, in many communities, individuals with OUD are sent to a drug court or linked to treatment and other supports when leaving jail. It is likely that many of these usual steps and supports are being bypassed with rapid release. People are being sent out the door and they are very vulnerable,” she said.

Similarly, some treatment and detox programs are no longer currently serving clients. “On a normal day, someone who is leaving an abstinence detox facility is at extreme risk for a fatal overdose. This may be even more likely now, because these individual are limited in their ability to connect with a support system when they get out. It is essential that these individuals and their loved ones have access to naloxone (Narcan) in case of an overdose,” Reynolds said.

Reynolds also worries about less emergency care resources being available for people with opioid use disorders during a pandemic. Many providers report “compassion fatigue” when treating patients with opioid use disorder under normal conditions. Right now, health care providers and the resources at their disposal are being stretched beyond their limits. These professionals are working under extremely stressful conditions to care for people affected by COVID-19, in additional to their normal patient load. Individuals presenting at the hospital with a drug overdose may be at increased risk for less than optimal care.

Reynolds offers the following practical guidance for people with OUD and the people who support them:

  • Get Naloxone (also known as NARCAN). “If you are at risk of overdosing or if you have a loved one with OUD, get Naloxone. Have it at home and carry it with you. Know how to use it. Tell your loved ones where you keep it. That’s going to save a life,” she said. Naloxone can reverse an opioid overdose when used quickly. It’s available without a prescription at pharmacies in most states. The website is a great training resource for responding to an opioid overdose for both first responders and bystanders.
  • If you are in treatment, stay engaged in treatment. “If you’re taking medication for opioid use disorder (also known as medically assisted treatment), keep taking your medication and contact your provider about tele-health.” The Substance Abuse and Mental Health Services Administration in some states has allowed patients taking MOUD a 28-day supply of their medication. Talk to your doctor about getting the medication you need.
  • If you are not yet it treatment, seek it (if you are ready). Also seek overdose prevention services through a local syringe services or harm reduction program.
  • If you’re in recovery, stay in recovery as best you can. The group Shatterproof has great information about finding virtual recovery support. “Social distancing does not have to mean social isolation,” Reynolds said.
  • Check in on your loved ones. “If you love or support someone with an opioid use disorder, check in on them and make sure they are okay. Stigma related to opioid use disorder is high on any given day. With something like this they are perhaps even more vulnerable,” Reynolds said.
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Opioid abuse crisis in Appalachia

Since 2016, ORAU has traveled to six Appalachian states training more than 30 anti-drug coalitions, not-for-profit organizations, local health departments, emergency responders and law enforcement agencies through an Opioid Prevention Social Media Training and Technical Assistance Program. The program trains local organizations to more effectively use social media to communicate with the public about opioid misuse and abuse.

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