Over the last 30 days, a plethora of information has come from scientists on the terrible impact that Covid-19 is having on already at-risk populations. Both rural and urban people who use drugs are more at risk than ever before from overdose, as social distancing makes using drugs alone more common, and there are many other similar concerns that invariably impact poor people, rural people, and people with existing substance use disorders and other mental health problems. I will concentrate on one specific concern that I have been worried about for months now, because I have become aware of many over-regulated portions of the substance abuse treatment industry, and some of those regulations make it impossible for people with the addiction-related disease to get proper treatment during this pandemic.
The specifics of the policies I want to talk about pertaining to the program of medication-assisted treatment. In Alabama, doctors do not have free access to methadone when it comes to prescribing the drug to their own patients for substance use disorder. Alabama has a similar system to both Indiana and Florida. At the best rehabs in Alabama, my understanding is that they have only buprenorphine when it comes to medication-assisted treatment (MAT) for opioid use disorder patients. Alabama rehabs do not have access to methadone for their patients, as far as I can tell, so the state has a small number of methadone treatment facilities. A quick glance at online reviews tells me that the methadone treatment system in Alabama is incredibly deficient when it comes to patient care, as are most systems of that kind. This regulatory issue of doctors being restricted becomes a huge problem during a pandemic such as Covid-19. Methadone treatment centers are overcrowded, by definition, because there are not enough of them during a crisis of opioid addiction and they are over-regulated, so virtually nobody can open more. Social distancing is borderline impossible when you consider overcrowded facilities and a system that forces patients to show up each and every day to get one dose of their daily medication. Methadone treatment centers in these states are not allowed to simply give their patients larger supplies, and there is no way for doctors to take on any of these patients because they are barred from ever prescribing methadone for substance abuse. In the ultimate irony, doctors are not barred from prescribing methadone for pain, a problem it is almost never used for anymore. Imagine if you went to your doctor, because you were sick, and the doctor told you there was a medication out there that would help you, but that the government does not allow him or her to prescribe it. That is the reality that people with substance use disorder live with every day.
If you or a loved one is in the unfortunate situation of needing substance use disorder treatment, you will undoubtedly realize that there are roadblocks at every turn, and there is no good reason for the roadblocks. The people that work in rehab clinics in Alabama, and all the dedicated people in this country that work in addiction medicine, must treat patients every day with one hand tied behind their backs. The government had no problem allowing pharmaceutical companies to rake in profits by filling up American households with addictive opioid medications of higher and higher potency, but when it comes to helping the addicts that are created from our system over the last two decades, most people simply do not understand or know enough about this giant issue. The science around this problem is crystal clear; regulations must be eased during Covid-19, and the substance use treatment industry has needed these restrictions to be eased for years, but some experts do not think that it will happen. Here is an excerpt from a very timely research study that was just published in the last month by the National Institute of Health. As an aside, many people in government know about and care about this problem. It is just not the part of government that has the power to make changes. It is doctors and scientists, social workers, nurses, and substance use disorder treatment workers that study these issues and make recommendations, and politicians ignore those recommendations because they do not care about these issues. Someday, if the opioid crisis continues, so many people will be dying that something will be done, but right now more people are dying from overdoses than almost any other cause, and very little is getting done to change that fact. Now the excerpt from the new NIH study,
“Providers who work on the front lines treating persons with substance use disorders have made compelling cases for addressing the burdensome regulations that stand in the way of improving the patient care experience, improving the health of a population that is among the most vulnerable, and reducing per capita health care costs. Similar calls, even in past natural disasters, have gone unheeded. Today, restrictions in care and associated stigma experienced by persons with substance use call for immediate recommendations for system changes. As regulations are lifted to provide essential treatment and support to those with substance use disorders, it timely for healthcare researchers to examine the impacts, benefits, and unintended consequences of these special exemptions, thus informing which easements should remain permanently in place.”
I hope that my comments about drug rehab protocols in states like Alabama are not being misunderstood. I am simply repeating the message that is coming from these experts in the field. They cite past natural disasters, none as large as the Covid-19 pandemic, and they clearly state that nothing was done to help addicts then, and they hope that something can be done in places like Alabama, Florida, and my home state of Indiana, to help people seek drug rehabilitation and treatment. People in rural communities and people in cities like Dothan and Enterprise Alabama need help from people in powerful positions during this perilous time.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
Traci C. Green, Jeffrey Bratberg & Deborah S. Finnell (2020) Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment, Substance Abuse, 41:2, 147-149, DOI: 10.1080/08897077.2020.1752351