I am a primary care doctor who has recovered from — and who treats — opiate addiction. I work in an inner-city primary care clinic in Chelsea, Massachusetts, which currently has the highest rate of COVID-19 in the state, due, in part, to poverty. These two experiences offer me a clear view of how these two epidemics — COVID-19 and opioid addiction — can impact and worsen each other. Two great epidemics of our generation are intersecting in ways that are additively deadly, and which highlight the urgent ways we must respond to some of the underlying fault lines in our society that are worsening both crises.
Social determinants of health create greater vulnerability
People who suffer from the disease of addiction are particularly vulnerable to both catching the coronavirus and having a more severe disease when they do catch it. There are many reasons for this, but they boil down to something called social determinants of health, which according to the CDC are “conditions in the places where people live, learn, work, and play [which] affect a wide range of health risks and outcomes.” In short, people suffering from addiction are vastly more vulnerable to coronavirus, as they are more likely to be homeless, poor, smokers with lung or cardiovascular disease, under- or uninsured, or have experienced serious health and socioeconomic issues from drug addiction. There are also millions of vulnerable incarcerated people, many of whom are stuck in jail due to their addictions and related nonviolent drug offenses.
Treatments and support systems may be disrupted
For someone struggling with addiction, virtually all of the services and treatments available to them have been disrupted by the COVID-19 epidemic. People are told to stay home, which directly contradicts the need to go to clinics to obtain methadone or other medications for treating addiction. Our government, in response, has relaxed regulations so that, in theory, clinics can give 14-day or even 28-day supplies to “stable” patients, so that they don’t have to wait in line and can adhere to social distancing for safety. Unfortunately, there are countless stories of patients not being granted this privilege, including at least one of my own patients.
Similarly, the government has relaxed some restrictions on buprenorphine prescribing, and has allowed some telephone prescribing, but this presupposes that there are doctors available that are healthy and certified to prescribe this medication, and that the pharmacies and doctors’ offices are functioning. Access to clean needles is affected as well. Additionally, may rehab facilities have limited new admissions, cancelled programs, or even shuttered their doors for fear of spreading coronavirus in a communal living setting.
Social isolation increases the risk for addiction
A common truism in recovery culture is that “addiction is a disease of isolation,” so it stands to reason that social distancing — in every possible way — is counter to most eff