The US was already grappling with an epidemic of opioid overdoses. People in recovery say the coronavirus outbreak has made getting treatment a nightmare.

Courtesy of Leslie Beckham Lesley Hann (right) and her boyfriend, Tim Paprocki (left).

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Deaths from drug overdoses are likely to increase during the coronavirus outbreak because of disruption to recovery routines and access to treatment, according to counselors and people whose rehabilitation depends on daily care.

Lockdowns and social distancing have forced doctors, social services, and support groups to shut down, reduce hours, or move online — leaving people who use drugs and those in recovery to face greater risks with less support. The coronavirus emergency has also presented new problems for people being treated for opioid use disorder — the medical term for opioid addiction — at methadone clinics. In order to collect their daily doses, patients typically have to go in person, which has made social distancing impossible for some. Service providers in New York, which is now the epicenter of the US coronavirus outbreak, say they don’t have the resources to handle delivery for all of the patients who are likely to become ill and require quarantine. Patients have long feared what would happen if their treatment became unavailable. “This is stuff that in recovery folks that are on methadone talk about — ‘Oh my gosh, what if there was an apocalypse ha ha ha ha and we couldn’t get our doses?’” said Leslie Beckham, who has been in treatment programs on and off for six years, and now attends a clinic in New London, Connecticut. “It’s kind of a running joke a little bit, but now it’s serious.”

Courtesy of Leslie Beckham Leslie Beckham

With countries closing their borders and movement restricted, recovery advocates are worried that opioid use will become more dangerous. If supplies diminish, opioid dealers will likely be tempted to cut drugs with more dangerous substances, like fentanyl, even more than they do already. In an ideal world, this would lead to more people seeking treatment — but for many, the cost of the medication is prohibitive. “The people who were getting help aren’t really getting any help right now at all. Put that on top of trying to stay clean, and you’ve got yourself one hell of a day,” said Danny Pont, who is part of an opioid treatment program in Rhode Island. “I suspect there will be a lot of relapses — and with a lot of relapses, there’s going to be an uptick in overdoses,” Pont added. Nearly half a million Americans have died from overdosing on drugs in the last decade, and preliminary CDC data suggests another 69,000 people died in 2019. The opioid epidemic was declared a national emergency in 2017, but advocates from across the country told BuzzFeed News they’ve never received the resources needed to fully address the crisis. Gary Mendell, founder of advocacy group Shatterproof, estimated the cost of adequate funding to address the crisis at around $50 billion a year. The federal government only spent around $7.4 billion in 2018. If it was already difficult to deal with the opioid crisis on its own, facing it amid the coronavirus outbreak will be extremely challenging. “I don’t think anything like this has happened before,” said Devin Reaves, who runs the Pennsylvania Harm Reduction Coalition. “I can’t remember a time in my life where there were actually two national declared public health emergencies.” Methadone clinics and other medication-assisted treatments — like buprenorphine — for opioid use disorder have proven effective. But the medications are also subject to strict regulations over how and when patients can receive them, due to real risks of overdose, resale on the black market, and long-term stigma against the drugs, which some see as simply trading one addiction for another.

Courtesy of Danny Pont Danny Pont

To combat these concerns, methadone patients are typically required to come in person each day to a clinic, where they may face long lines and drug-testing before getting their personalized dose, which must be taken in the presence of clinic staff. The coronavirus outbreak has created a new risk from the in-person nature of the clinic, and both patients and doctors who spoke to BuzzFeed News expressed concern about the need for social distancing. In response to the outbreak, the Substance Abuse and Mental Health Services Administration issued emergency guidelines on March 16, relaxing restrictions on medication-assisted treatment. The new guidelines allow doctors to prescribe buprenorphine via telemedicine, advise methadone clinics to give stable patients take-home doses in order to reduce crowding, and recommend delivery to patients in quarantine. The changes have been a source of optimism for some advocates, who told BuzzFeed News that such measures are long overdue and hope they will become the new normal when the coronavirus pandemic ends. Dr. Sarah Johnson, the medical director at Landmark Recovery, a network of addiction treatment centers based in Louisville, Kentucky, said she was blown away by the recommendations and saw it as evidence of government officials’ recognition of the essential role of medication in fighting the overdose crisis. She said the changes were dramatic. “It’s like the Wild West,” she said. “In the matter of a one-week period, this went from one of the highest-regulated areas of medical practice to an area where there were lots of exceptions to rules that have been in place since the ’70s.” But the new guidance has been haphazardly adopted and in some cases impossible to carry out, advocates say. In New York City, where there are around 28,000 methadone patients, more than half could become sick and need to be quarantined over the coming months, according to Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) in New York. The new guidelines say that clinics should provide home delivery for anyone who doesn’t have a third party able to retrieve the medication. Given the restrictions, Schorr estimates that this would make clinics responsible for thousands of home deliveries, which she says is far beyond the capacity of clinic staff. “That may be upon us very quickly,” Schorr warned, saying COMPA was seeking help from state and federal agencies to meet the needs of New York. “It’s the size and the scope that becomes so worrisome,” she said. Opioids like heroin and fentanyl — and most of the medications used to treat addiction to those drugs — create a physical dependency in many people who use them, driving the need for a new dose or else risk going into withdrawal. If clinics are not able to find a way to deliver the medication, patients will either be forced to continue coming in person and risk spreading the coronavirus further or be left to face the consequences, which can include severe flulike symptoms, vomiting, diarrhea, and shaking, mixed with anxiety and depression.

Courtesy of Leslie Beckham A sign at the methadone clinic that Leslie Beckham and Lesley Hann attend in New London, Connecticut.