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Messenger: Those on front lines of opioid crisis worried about coronavirus aggravating the battle

Messenger: Those on front lines of opioid crisis worried about coronavirus aggravating the battle

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Percy Menzies, president Assisted Recovery Centers of America

Percy Menzies, president Assisted Recovery Centers of America, or ARCA, talks about the success he's seen using Vivitrol to treat people with opioid addictions at his office in St. Louis on Wednesday, March 29, 2017. Photo by David Carson, dcarson@post-dispatch.com

For several years, Chad Sabora has been on the front lines of what was the crisis of the day — or one of them at least — before the coronavirus pandemic swallowed the nation.

The opioid crisis.

It didn’t go away. In fact, one of the most devastating results of the spread of COVID-19 is that it affects some groups of people in higher proportion who were already struggling.

People without shelter. Others fighting addiction. Folks in jail or prison. Seniors in nursing homes.

“The coronavirus pandemic made an impossible task even more impossible,” says Sabora, co-founder of the Missouri Network for Opiate Reform & Recovery.

Sabora, who has battled his own addiction demons, is worried that the second crisis is going to make the first one worse, and the damage will be hard to see for a while.

Dr. Fred Rottnek shares Sabora’s concerns. Rottnek is the program director of the Addiction Medicine Fellowship at St. Louis University School of Medicine, and he also practices at the Addiction Recovery Centers of America, founded by Percy Menzies.

“If people have substance abuse problems, and they lose their jobs, and are at home isolated, you’re going to be thinking about using all day long,” he says.

The coronavirus pandemic has created a paradox for Menzies and Rottnek.

Both have been at the forefront of trying to unite the medical community and the addiction community toward a solution that makes methadone and buprenorphine (known commercially as Suboxone) more easily available for patients to help them manage their addictions.

In late January, before the pandemic had spread to the U.S., the two men made this point in a letter to the editor in the Post-Dispatch, critical of the state of Missouri for firing its top opioid crisis consultant, Ned Presnall. The Washington University researcher had been pushing the state to change its philosophies and to make access to medicines a more significant part of its strategy.

“The restrictions on prescribing methadone and buprenorphine have created barriers for the medical community to get involved,” Menzies and Rottnek wrote. “As a result, less than 20% of the patients needing medications for opioid treatment receive them. Treatment centers providing counseling-only services are increasingly referring patients for medical treatment, and this trend is growing.”

The coronavirus pandemic changed things overnight, but without much planning and foresight.

Because of social distancing requirements, the federal government loosened restrictions on the amount of methadone and Suboxone a patient could get at one time, so they could have more medicines at home. Previously, nearly all methadone treatments had to be given in person.

Now patients are allowed to have a week’s worth of the medication that Rottnek calls “very dangerous.”

“It’s not going to be pretty,” Rottnek says. “All of a sudden you have a highly potent synthetic opioid that is something they could easily overdose on.”

The increased access to Suboxone is less worrisome because it doesn’t lead to overdose deaths in the same way methadone can.

Sabora agrees that there will likely be some methadone overdoses in coming weeks and months. But he thinks the benefits of loosening up access to the drugs will have more value to those battling addiction in the long run.

What he’s more concerned about is the availability of Narcan, the life-saving drug that can reverse the effects of an overdose. Over the past few years, Sabora and others have been successful in getting the drug in widespread use, putting it in the hands of police officers and firefighters and volunteers who come in contact with patients on the street most likely to need it.

Now, like masks and other protective medical equipment, getting it is more difficult. Distributing it to the people who need it, who don’t have access to addiction centers as they used to, is even more difficult.

The crisis is causing Menzies to offer increased telemedicine at his facilities, to try to get as much good information to people battling addiction as he can. But all the men are worried with what comes next.

“There are no easy answers to this,” Menzies says, of dealing with one crisis that is likely to be made worse by another. “I’m very concerned.”

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