The coronavirus has been a stressor for pretty much everyone. But that stress is amplified for people with addictions, according to Dr. Jennifer Wood.
Wood is an assistant professor and psychiatrist at the University of Louisville. She works at UofL’s general psychiatry outpatient clinic and hospital, where she focuses on patients with addictions to alcohol, opioids and other substances.
“It's been a challenge at times,” she said. “But it's also been hopeful at times, I think, seeing how patients and the healthcare workers can adapt to still deliver really quality care.”
The opioid epidemic became a focal point nationally and in Kentucky over the past decade, as overdose deaths spiked to previously unseen highs. Initiatives to limit the availability of opioid prescriptions, improve treatment methods and increase awareness of the public health crisis followed.
Those efforts seemed to pay off in 2018, when overdose deaths dropped for the first time in nearly 30 years. But then came the pandemic.
“Addiction is extremely important and relevant, especially in Louisville,” she said. “I think that the pandemic has put that on the backburner a little bit, although we're starting to talk more about how the pandemic has influenced addiction.”
That influence has led to some concerning trends.
“We know that substance use is up,” Wood said. “We know that drug overdose deaths are up. And I think that seeing some more of these reports coming out of states across the nation is really raising some of these red flags in public health.”
Wood’s patients are facing increased isolation, loss of routine, lack of employment and financial strain due to the pandemic. Those struggles aren’t exclusive to people with addictions. But for them, sudden changes in life circumstances can lead to higher rates of drug use and relapse.
Wood said even the process of treatment has gotten harder.
“Patients who were previously well-established in addiction treatment, for example, their clinics may have closed due to COVID, and they're not able to be seen in person anymore,” she said. “A lot have transitioned to telemedicine, but some have not. And that was a big disruption for a lot of patients who were formerly doing quite well in treatment.”
That shift also took a toll on Wood. When her clinic abruptly switched to telemedicine as COVID-19 cases ballooned, Wood had to become better acquainted with delivering care over digital platforms like Zoom. She also needed to ensure patients had reliable access to devices, like smartphones and computers, to continue their treatment.
Telemedicine sessions can require more mental effort from Wood to connect with her patients the same way she would face-to-face in her office. She said spending multiple hours a day delivering care through a screen has led to “virtual fatigue.” Finding ways to overcome that is just one of the challenges she and other providers have faced as coronavirus reshapes health care.
“A lot of it was, especially in the beginning, just getting used to the uncertainty,” Wood said.
But much of Wood’s concern over the past several months hasn’t been for her own well-being. Instead, she’s spent a lot of time thinking about her patients and how they’re coping.
“When it comes to addiction, I find myself worrying sometimes, knowing that people are more isolated out there,” Wood said. “People are not able to access their normal routines. Overdose rates are higher. It concerns me, and I think it's something that weighs on my mind.”
The switch to telemedicine had a noticeable effect on treatment, too. Attendance decreased, and some patients dropped out entirely.
But as telehealth treatment became more routine and patients became more familiar with the process, the situation improved. Wood said her patient attendance and treatment adherence are now similar to what they were before the pandemic.
Nearly all of Wood’s sessions with patients are one-on-one. During the meetings, she’ll ask patients how they’re doing, if they’re having any cravings and how their medications are working. Wood said a lot of patients now find the telehealth process more convenient.
“You can oftentimes, as long as you have a video, really get a good sense of how your patients are functioning and what their mental status is like,” Wood said. “You do lose some of the in-person data that you might get from an in-person exam, but I think for the most part, it's actually pretty effective.”
Prior to the pandemic, Wood’s office had patients come in for urine screens to make sure they were adhering to their treatment. Now, they’ve partnered with a lab that provides home visits. Federal agencies have loosened restrictions for prescribing medication-assisted treatments, like Suboxone, which Wood uses in her practice.
Moving forward, she hopes to see changes like those remain in place.
“We're having a lot of success with being able to prescribe Suboxone safely and effectively in a virtual way,” Wood said. “I think that's something that I hope will not necessarily go back to the more restrictive ways of prescribing in the future, even when the pandemic is over.”
Until the pandemic ends, Wood said she and other addiction treatment providers will strive to continue what they’ve been doing all year – adapt to whatever changes may be thrown their way to deliver the best care possible to the patients who rely on them.
RESOURCES
Crisis lines
24/7 crisis line: 502-589-4313
Center for Women and Families crisis line: 211
Suicide Prevention Lifeline: 1-800-273-8255 or chat here
Substance abuse-related support
UofL psychiatry clinic: (502) 588-4450
NA: https://na.org/?ID=virtual_meetings
Al-Anon: https://al-anon.org/al-anon-meetings/electronic-meetings/
SMART Recovery: https://www.smartrecovery.org/community
Buddhist Recovery: https://www.buddhistrecovery.org/meetingslisting/meetings/Telephone+-+Online.htm
Speaker tape websites
https://www.recoveryaudio.org/