Addiction Treatment is Essential During COVID-19

I’ve known for most of my medical career that treatment for alcohol and substance use disorders is an essential component of the healthcare system in our country. The medical establishment has known this for quite a while, too. Far longer than the general public. The sea-change in the medical community began in the early 90s, gathered momentum in the 2000s, and became status quo around 2010, when the Affordable Care Act required insurance companies to cover alcohol and substance use disorder treatment in standard plans.

What changed was this: we went from the point-of-view that addiction is a moral failing or character flaw — which was more opinion than science — to the evidence-based conclusion that addiction is a chronic, relapsing medical condition that can be managed with a combination of medication and lifestyle changes. Treatment for alcohol and substance use disorders follows a pattern similar to treatment for diabetes or hypertension: the major difference is that with addiction, therapy and counseling is an essential — and mandated — part of the treatment process.

That sea-change is now apparent in the general population as well. We can see it in the awareness campaigns aimed at reducing the stigma around addiction and addiction treatment, which were catapulted into national prominence by the opioid crisis. Though the coronavirus pandemic has eclipsed the opioid crisis in terms of national focus and immediate priorities, the opioid crisis focused our attention on addiction and recovery, teaching us that we should not view treatment for addiction any differently than we view treatment for other chronic illnesses.

Now that COVID-19 is here — and the most pressing public health issue we face — we need to understand that the opioid crisis did not magically vanish in March. People still struggle with addiction, and they still need our help every day: this was true in January, before anyone heard of the coronavirus, it’s true today, and it will be true when we get the COVID-19 pandemic under control.

Follow the Funding

I once heard a very smart person say this:

“If you want to know what a nation values, look at the line items in the national budget.”

That’s how I know that we’ve finally arrived at a place where we, as a nation, understand the essential necessity of addiction treatment. I followed the money and found that alongside allocating significant resources and adapting regulations around everything related to COVID-19, the federal government is doing the same thing for healthcare in general — and addiction treatment in particular.

Here’s what the Substance Abuse and Health Services Administration (SAMHSA) says in the introduction to their special “Emergency Grants to Address Mental and Substance Use Disorders During COVID-19” program:

“SAMHSA recognizes there are currently 57.8 million Americans living with mental and/or substance use disorders (National Survey on Drug Use and Health, 2018). The current national crisis of COVID-19 will certainly contribute to growth in these numbers. Americans across the country will struggle with increases in depression, anxiety, trauma, and grief. There is also anticipated increase in substance misuse as lives are impacted for individuals and families. The purpose of this program is to provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic.”

That program makes $110 million of funding available all U.S. territories, states, tribal lands, and other entities such as Puerto Rico and Washington, D.C. More than the money, though — which is a good start — it’s the language of the grant that’s encouraging to me, as an addictionologist. They recognize the relationship of the crisis to mental health, and understand that substance use disorder treatment is part of mental health: that’s important not only to my patients and myself, but to our entire country.

Telehealth and Medication-Assisted Treatment

In addition to allocating funding to support hospitals, clinics, and addiction treatment centers, the Centers for Disease Control (CDC), the Department of Health and Human Services (HHS), the HHS Office of Civil Rights (OCR), the Food and Drug Administration (FDA), and the Drug Enforcement Agency (DEA) have collaborated to temporarily ease the rules and regulations that govern medication-assisted treatment (MAT) for addiction.

This is crucial for the medical professionals who provide MAT (like me) and the patients for whom strictly regulated medications like methadone and buprenorphine are an essential component of treatment and recovery. For these patients, access to therapists and medication can be a matter of life and death. That’s no exaggeration — and that’s why federal, state, and local authorities are making it possible for MAT to continue, in a modified form, under the strict social distancing guidelines in place around most of the country.

Here’s what they’ve done to ensure MAT continues during the COVID-19 pandemic:

· Allowed states to request a blanket exemption for stable patients in Opioid Treatment Programs (OTPs) to receive 28 days of take-home doses of their medication (methadone, buprenorphine, naltrexone)

· Allowed states to request a blanket exemption for less stable patients in Opioid Treatment Programs (OTPs) to receive 14 days of take-home doses of their medication (methadone, buprenorphine, naltrexone)

· Allowed an exception to the rule that requires patients with a new diagnosis of opioid use disorder (OUD) to receive a complete, in-person physical examination before beginning MAT. What this means is that providers can use telehealth to diagnose OUD and prescribe buprenorphine. However, because of clinical details related to initial dosing and determining an effective therapeutic dosage for methadone — which varies by the individual — this exception does not apply to methadone, yet

· Allowed providers to continue to treat existing MAT patients via telehealth

· Allowed providers to continue to prescribe buprenorphine to existing patients via telehealth

· Allowed providers to continue to prescribe methadone to existing patients via telehealth

· Announced that enforcement of privacy guidelines regarding “widely available communications apps such as FaceTime or Skype” will be left to the discretion of the OCR and HHS. Penalties for violations of privacy will be waived when practitioners use them “in good faith for telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.”

The long and short of all of this is that, with regards to addiction treatment, authorities are doing everything in their power — and within reason — to ensure that people who need treatment for alcohol or substance use disorder can get that treatment during the coronavirus pandemic. That’s important for people with ongoing addiction issues, and it’s also important for people with emerging mental health or substance use issues. The isolation and stress surrounding the pandemic may exacerbate mental health symptoms, which, in turn, could lead to increased alcohol and drug use. Which, in turn, could lead to disordered use that requires professional support and/or intervention.

Consistency and Commitment

When people seek treatment for addiction, doctors (like me) often tell them they need to dedicate themselves to their recovery, work their program every day, and over time they’ll see results. In other words, they need consistency and commitment. I’m grateful the authorities recognize addiction treatment is an essential service, and I’m encouraged by the real steps they’ve taken — meaning line items in the budget and temporarily easing restrictions around MAT — to ensure that people with an alcohol or substance use disorder continue to receive the treatment they need.

This allows us to match the consistency and commitment we ask of them — even during tough times — with consistency and commitment of our own. Things right now are tough all over. They’re tough for people battling coronavirus, they’re tough for people working from home with kids, they’re tough for frontline healthcare workers exposed to COVID-19 every day, and they’re tough for people in recovery from addiction.

Times are tough, but so are we.

And thanks to the quick, adaptive response from the authorities with regards to addiction treatment — especially MAT — we can be confident that people in recovery will neither be forgotten nor left behind during this time of crisis.