Forgotten At Our Own Peril: The Opioid Crisis
Before the pandemic, it looked like progress was finally being made in addressing the opioid crisis. The medical community had tightened its prescription rules and new, effective treatments, like medication-assisted treatment (MAT), were becoming more and more widely available. Even the stigma surrounding drug addiction, a persistent social issue, was starting to wane. Then COVID-19 struck and the drug problem became worse than ever.
According to the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics, more than 100,000 Americans died of drug overdoses during the first year of the pandemic, an almost 30% increase from the year before. This news didn’t come as surprise to the doctors, nurses and emergency medical technicians across the University of Vermont Health Network, where the focus on the opioid epidemic hasn’t diminished, despite the pressing challenges posed by the COVID-19 virus.
“The number of patients that chose to enroll in MAT with us dropped dramatically but the percentage presenting with opioid use disorder or overdose remained very consistent,” says Daniel Wolfson, MD, an Emergency Department doctor at the University of Vermont Medical Center. He is a member of the team that runs the Start Treatment and Recovery (STAR) program, a treatment and research initiative created to expand access to MAT and connect patients quickly with community care providers for their ongoing needs. Fear of COVID-19 and, perhaps, misunderstandings about what services are available during the pandemic have likely contributed to the drop in enrollments.
The psychological effects of the pandemic have also impacted patients. “I think the sense of hopelessness that often accompanies addiction is only reinforced by what we’re experiencing here with the pandemic,” says Evan Smith, MSW, LICSW, the Behavioral Health Services Manager at UVM Health Network – Central Vermont Medical Center. “This has been a frustrating, stressful time for everyone, but people who are vulnerable to addiction have been struck particularly hard by the isolation and uncertainty of the past two years.”
‘We're Not Here To Blame or Judge’
“The big overarching message has to be: we are open and we want people to come in,” says Roz King, MSN, RN. King is another member of the STAR team, which recently expanded its operations to UVM Health Network – Champlain Valley Physicians Hospital in Plattsburgh, N.Y. “We’re not here to blame or judge; we’re just here to make things better, and we want to meet patients at any time of day, wherever they’re at.” In addition to MAT, she explained that harm reduction materials like Narcan, an emergency medication for opioid overdoses, and fentanyl testing strips, as well as counseling from peer recovery coaches are also available.
Because health care providers need to get what's called an x-waiver to prescribe buprenophrine, Emergency Departments are especially important resources for those suffering from opioid use disorder. In many cases, the ED is the only option available to patients at any time, on any day. Providing this flexibility has taken time and work, Dr. Wolfson says: “At the beginning of the STAR program, in February 2019, I was one of only a few doctors in the Emergency Department who had that waiver – now most of our providers have it, which allows us to ensure basically 24/7 access to MAT.”
‘The Window of Opportunity Closes Very Quickly’
Buprenorphine is one of the medicines used in MAT for opioid use disorder. It’s a less euphoric, longer-lasting opioid that helps patients endure withdrawal from dangerous substances until they can start to live without them and receive other types of care and support. Offering the option to pursue treatment whenever patients are ready is an integral part of helping those with opioid use disorder. “The window of opportunity closes very quickly,” Smith says. “A few hours later, the withdrawal symptoms might be too severe for someone to feel prepared to stop using.”
The spread of fentanyl, a synthetic opioid considered 100 times more powerful than morphine, which experts say is a major driver of the recent rise in overdose deaths, has only increased the UVM Health Network’s motivation to break down barriers to treatment. “We’ve kind of pivoted from an opioid epidemic to an overdose epidemic because of the potency of fentanyl,” says Kyle DeWitt, Pharm.D., BCPS, a pharmacist clinician in the Emergency Department at UVM Medical Center. “And these days, finding drugs with fentanyl in them is more common than finding them without.”
At this point, it's outreach, not effort, that providers say could use some improvement. “The work in our Emergency Department, and throughout the Network, has continued this whole period and the shift has been huge,” says Nick Ferrigno, MS, A-EMT, a UVM Medical Center Clinical Research Coordinator and Emergency Department Technician involved in the STAR program. “Even though the public has turned its attention to COVID-19, we’ve been making progress, and we want to share that progress with as many patients as possible, so we need to let people know that we’re here for them.”