Although her weekly therapy appointments are now virtual, Melissa, who is being treated for opioid-use disorder, has a monthly appointment for medication at Cooper University Health Care’s Center for Healing. Photo by Jauhien Sasnou
It was February, and Melissa had decided it was time to get clean again. She reconnected with her team of addiction-medicine doctors and began the recovery process. But by mid-March, about one month into her treatment for opioid addiction, the Covid-19 pandemic began to ravage New Jersey.
Melissa (who asked that we use only her first name) remained determined. A 32-year-old mom, she had her son to think of.
Working with doctors at Cooper University Health Care’s Center for Healing, Melissa transitioned to partial virtual treatment. Her weekly in-person therapy appointments became video or phone meetings. All these months later, she has stuck to the center’s recommended routine.
Things are working out for Melissa, who, despite the stress of the pandemic, has been clean since starting treatment. But for some patients with opioid-use disorder, the ripple effects of Covid-19 have exacerbated their condition.
“We have an epidemic in the midst of a pandemic. Where those two meet has been very difficult,” says Iris Jones, manager of clinical operations at the Center for Healing. Since March, Jones, who is also an addiction-medicine therapist, has seen patients report increased depression, anxiety and intimate-partner violence. Those factors, paired with layoffs and lack of childcare due to the pandemic, can hinder recovery, says Jones.
Even before then governor Chris Christie declared opioid addiction a public health crisis in New Jersey in January 2017, fatal drug overdoses had been on the rise in the state. Between 2014 and 2015, drug-overdose deaths increased by nearly 22 percent in New Jersey, with almost 1,600 people losing their lives in 2015 alone. By 2018, the number of fatalities was up to 3,006. Preliminary 2019 data shows a slight increase to 3,021. (Meanwhile, the opioid prescription rate has been decreasing since 2015, according to data from the New Jersey Prescription Monitoring Program.)
Newer numbers suggest that Covid-19 has added to the crisis. At the height of the pandemic, from March through May, there was a 19.3 percent increase in suspected drug-related deaths in New Jersey compared to the same period last year. The largest jump occurred in May, according to an analysis of statistics from the New Jersey Department of Health’s Opioid Data Dashboard. Through the end of August, there were 2,093 suspected drug-related deaths in New Jersey this year.
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Before she sought treatment, Melissa’s life had revolved around getting high. She bounced between houses in Camden, staying with people she knew. Her days focused on using and selling drugs: prescription pain relievers, like Percocet and Roxicet; illegal substances, including heroin and cocaine; Xanax, the anti-anxiety drug; and Suboxone, a treatment for opioid dependence.
“Things just went so bad so fast, and it completely took over my life,” she says.
Still, her former clean life beckoned. Each month, someone from the addiction-medicine clinic where she had previously been a patient reached out about making an appointment. Her teenage son often called and asked when she was coming back. “I’ll be home when I feel better,” she would say.
Finally, “something made me snap out of it,” she says. “There was just this strong sense that everything was wrong. And I [didn’t] want to go down any further.”
Melissa went to her parents’ home in Cherry Hill, where her son was living, and vowed to get treatment.
Like other patients with opioid-use disorder, Melissa’s treatment routines had to be adapted to protect against Covid-19. The Center for Healing, which provides a variety of services throughout the South Jersey hospital system, developed a schedule for Melissa that included virtual counseling sessions and a monthly in-person appointment for her injection of Sublocade, an extended-release medication used to treat opioid addiction.
To deal with the simultaneous public health emergencies, Cooper’s Center for Healing turned its appointment-only addiction-medicine clinic in Camden into a low-barrier walk-in center. The small team has seen nearly 90 new patients monthly since the clinic transitioned in March. By comparison, the facility admitted about 25 new patients in February.
“We as a team recognized that we could not stop providing care in the midst of this, because we will lose more people to overdose than we’re going to lose to Covid,” says Jones.
The goal of Cooper’s walk-in clinic is to provide immediate access to treatment to mitigate the potential for overdose, a life-threatening emergency that occurs when a toxic amount of a substance or combination of drugs is ingested. Not all overdoses are fatal.
Other New Jersey hospital systems also offer recovery services for those with opioid-use disorder, including Hackensack Meridian Health’s Carrier Clinic, RWJ Barnabas Health’s Institute for Prevention and Recovery, and Atlantic Health System’s behavioral health department.
As a result of Covid-19, particularly at the height of the pandemic, addiction-medicine specialists had limited access to external resources, such as shelters and support groups.
“The places I would have normally referred patients to were not able to accept new patients,” says Jones. “We couldn’t then make those connections. So that was really hard for patients, and it was hard for us, too.”
Dr. Noel Ilogu, a primary-care physician and addiction specialist in Somerset, has had some patients with opioid-use disorder relapse or overdose in the face of this pandemic due to increased stress and depression.
“Unfortunately, the pandemic itself worsened the prevalence of the addiction,” says Ilogu. “Patients often look to their addiction as a crutch, something to help them cope with difficult situations. And this pandemic has been very difficult on various levels.”
Increased isolation is one of those issues. Diminished social opportunities due to the statewide lockdown may have contributed to the rise in suspected fatal drug overdoses. “Sometimes, people end up being isolated and found dead because they’ve been using [alone], unlike before, when they might have people around them,” says Ilogu, who is also an attending physician at Robert Wood Johnson University Hospital and Saint Peter’s University Hospital in New Brunswick.
Another byproduct of isolation is the loss of support. “Connections have been fractured,” says Jones. “If a person had a support system through their family, but they stopped seeing their family because of the risk of Covid, especially if they had gone into the hospital or had been into our office, people lost connections and they lost support.”
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To combat these hurdles, New Jersey has rolled out initiatives to help overcome the opioid epidemic during the pandemic. In May, the state’s attorney general, Gurbir Grewal, in partnership with the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJ CARES), began requiring health care practitioners who prescribe opioids for the management of chronic pain to co-prescribe the opioid antidote naloxone to certain at-risk patients to avoid possible fatal overdoses. On August 31, which is International Overdose Awareness Day, the state was awarded $7.1 million in federal funds to further combat drug overdoses and expand services in the state.
The expansion of telemedicine appointments and virtual 12-step groups like Narcotics Anonymous has assisted some patients, although virtual rehabilitation opportunities are only available to those who have Internet access or phone data as well as devices with cameras.
“Although [telemedicine] has been helpful,” says Ilogu, “it has not completely eradicated the need for face-to-face encounters. You can’t even begin to manage the person by telemedicine if they are in withdrawal, or they have relapsed, or they’re in a bad state. That certainly needs a fairly high level of care.”
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While the pandemic has posed new issues for the addiction-medicine field, the protocols implemented as a result of the coronavirus have helped put some patients on a better track. “Some patients who had previously not been stable, stabilized quite a bit,” says Jones. “They were in the house, they weren’t going to normal activities or around their normal population.”
Melissa—who lost her father to cancer in July—says her treatment routine has helped her focus on her recovery.
“I actually prefer being on the phone. It helps just to talk to someone and not be in such a clinical setting. It’s just more casual, instead of having to go to [Camden] where there’s all these triggers,” she says. “Before, when I was going once a week, I would stop and think, I used to get high over there, or, I used to pick up my drugs from that spot down there. It’s hard to be around.”
Although she started her recovery before the pandemic, Melissa emphasizes the value in receiving immediate assistance.
Back in February, Melissa scheduled an appointment at the Camden clinic in a matter of days. “They got me in really quick, which really helped,” she says. “If I had to wait a while, I don’t know if I would still have had that resolve to get better.”
Other patients shared a similar sentiment with Jones at the Camden clinic.
“It’s really hard to staff that model because it can lead to provider burnout,” she admits about the no-appointment-needed treatment center, “but overall, the service that it provides to the community, and the way patients feel when they’re like, ‘Oh my god, the moment I asked for help you made it available’—that level of relief feels really rewarding for us.”