HJNO Jul/Aug 2021

HEALTHCARE JOURNAL OF NEW ORLEANS  I  JUL / AUG 2021 51 Jan Kasofsky, PhD Senior Vice President of Behavioral Health & Human Services Access Health Louisiana Loss of income placed more pressure on those who had been employed, but also lump sum financial benefits made return to drug use easy. Drug use in isolation left no chance for an overdose reversal with naloxone. It was hope that kept so many with an opioidusedisorder (OUD) going, their fam- ilies encouraging them and their treatment professionals, sponsors and support staff finding innovations to serve them. A re- cently published study of over 900 people with substance use disorders, published by the Patient-Centered Outcomes Research Institute, identified the following priority outcomes: staying alive, improving quali- ty of life, reducing harmful substance use, improving mental health, meeting their basic needs, increasing self-confidence/ efficacy and increasing connection to ser- vices and supports. Proven strategies such as harm reduction meet people where they are and are powerful tools to address the real desire for “staying alive.” Early in the pandemic, many treatment providers and support groups migrated to virtual platforms, and treatment was made available through phone connections. Many individuals who received telehealth sessions and who joined support groups virtually, stated that they preferred the convenience and anonymity of the virtual approach. Access to treatment known as medica- tion assisted treatment, or MAT, seen as the gold standard for helping individuals with an OUD safely transition to recovery, was expanded. MAT decreases the crav- ings and the fear of withdrawal; it com- bines the use of a prescribed medication with ongoing counseling. Without ongo- ing MAT, over 90% of the patients relapse even after adequate detoxification and a 30-day inpatient rehabilitation program. They are also at a high risk for overdose. The pool of treatment providers and those able to offer MAT to more individ- uals was expanded by the Drug Enforce- ment Agency, which allowed for payment of telemedicine appointments for the pre- scribing of controlled substances and early refills. Access to prescribing medication such as buprenorphine was made easier for prescribers without the lengthy train- ing previously required by the U.S. Depart- ment of Health and Human Services. The treatment system for individuals with OUD is far from perfect, but many lessons were learned that will improve and expand available treatment options. Aside from the reopening of treatment facilities, there are now more MAT providers and virtual options available. Recovery is hard, and it is extremely important to understand addiction as the disease it is; it requires empathy and op- portunities for an opioid-free life with connections, support and a life worth liv- ing. Postscript: My thanks to Arwen Podes- ta, MD, Podesta Wellness, and Jennifer Velander, MD, LSUHSC, for contributing to this article. n linked to synthetic opioids and illegal fen- tanyl increased 38.4% from May 2019 to May 2020. Many of today’s opioid addictions be- gan with legitimate prescriptions. Opioids such as oxycodone (OxyContin, Percocet) and hydrocodone (Vicodin) are synthetic narcotics. These medications were initial- ly accepted as nonaddictive panaceas for pain relief. Once their addictive nature was understood, prescribers offered alterna- tives, but many patients sought relief from street drugs, including pills and eventu- ally heroin. There are legal consequenc- es and serious health risks related to the questionable content, contamination and dosage of street drugs. Injecting drugs in- creases risk for HIV, hepatitis, sepsis and other diseases. It is not uncommon for in- dividuals to engage in illicit and dangerous activities to pay for their drugs. COVID-19 made life even harder for those with an addiction. Aside from the generalized anxiety and increased levels of depression many experienced, isolation and social distancing all but shut down treatment and supports for people work- ing toward recovery. Fears of a COVID-19 infection kept people from entering emer- gency rooms, detoxification services and treatment facilities. The 12-step sup- port groups such as AA, NA and Al-Anon scrambled to continue virtually, and little to no outreach occurred. Treatment facili- ty closures drove many patients back into environments with active drug use or back where relationships had long since soured. “COVID-19 made life even harder for those with an addiction. Aside from the generalized anxiety and increased levels of depression many experienced, isolation and social distancing all but shut down treatment and supports for people working toward recovery.”