Learning from COVID-19: Catalyzing Change to Address the Overdose Crisis

June 10, 2020

The past few months have been marked by unimaginable tragedy. The COVID-19 pandemic has already claimed more than 100,000 lives across the United States, with the greatest on Black and Latinx communities demonstrating the ongoing impact of racism on health. COVID-19 and a series of racist murders at the hands of police and vigilantes have painfully reminded us of the ultimate pandemic which has been afflicting our nation since our founding; Racism. Thousands have taken to the streets in protest and solidarity. The power and size of this movement as well as the rapid changes that have occurred in the months since the COVID-19 pandemic began were both unimaginable prior to this crisis.  In a moment marked by the indifference and brutality of racism and a deadly new virus, there have also been reasons for hope. Seeing the diversity of people marching in solidarity with shared passion for the urgent moral stakes of this moment has been moving. In addition, the compassion and flexibility of our health care workforce, frontline workers, and fellow community members during COVID-19 is inspiring.

The pace at which these dramatic changes occurred is breathtaking: day after day of protests, new street names in honor of Black Lives Matter, new intensive care units created overnight, entire systems of virtual health care established and funded, new public health models to help quarantine people who don’t have the luxury of social distancing, and field hospitals built in record time.  Despite the difficult work of being a doctor, a mom, and a citizen during these surreal times, I’ve felt renewed by how we have come together to focus our collective attention on caring for our fellow human beings and righting the horrific wrongs of racism.

If we can create these monumental changes amidst a crisis, imagine what we could accomplish if we focused the same energy on a different, devastating public health crisis of overdose.

People who use drugs, including those with opioid addiction, are among the populations most vulnerable to COVID-19. Racism has also deeply impacted outcomes for Black and Latinx people who use drugs, from our racist drug policies resulting in mass incarceration to access to care disparities. Limited access to stable housing; exposure to congregate settings in jails and prisons, treatment programs, and shelters; chronic medical conditions; and structural inequities leave our patients at greater risk of infection and death.

Many of the same social determinants that accelerated the spread of COVID-19 have also fueled the addiction and overdose crisis in this country.  In addition, the social isolation and loss of economic opportunity caused by the COVID-19 pandemic will likely worsen outcomes for people with addiction by increasing despair and ongoing drug use.

Psychological despair and socioeconomic disadvantage, both of which are worsening during this public health crisis, are two major factors fueling the ongoing overdose crisis.  These factors, combined with a dangerous illicit drug supply contaminated by fentanyl and other synthetics, could lead to a surge of overdose deaths and other substance-related harms.

Thankfully, we have the ideas and tools to prevent that.

A silver lining of COVID-19 has been changes to the historically rigid regulations around access to addiction treatment, including lifesaving medications like methadone and buprenorphine.  These medications are the only treatment proven to reduce the risk of dying from opioid overdose, and yet many barriers limit availability for people who need them.

Massachusetts is thankfully one of the states that has incorporated new federal requirements that relax some of the restrictions around medication treatment for opioid addiction.  This means that patients aren’t necessarily required to receive daily methadone dosing and that buprenorphine treatment can be initiated via telephone visit.  These changes are promising and will hopefully become permanent.  But much more must be done to expand flexible and equitable access to treatment and to promote outreach about the availability of said treatment. There are longstanding racial disparities in access to buprenorphine treatment, with Black individuals much less likely to receive treatment than whites. Advancing anti-racism in addiction treatment requires structural changes to these care models, and these regulatory changes are a first step.  It is my hope that these actions will allow individuals to access the care they need for the first time.

The COVID-19 pandemic has also demonstrated our communities’ impressive ability to establish housing to support public health efforts and keep more vulnerable individuals safe.  Across Massachusetts, there are innovative models which include partnerships with hotels, the use of convention and exposition spaces, or even utilizing shuttered long-term care facilities to provide safe shelter and clinical support to people experiencing homelessness or who live in close quarters to others.

In the context of the fight to end the overdose epidemic, these models could offer spaces for medically enhanced addiction treatment or short-term respite with addiction care for people who do not have access to traditional opioid use disorder treatment or need simultaneous medical care, like treatments with intravenous antibiotics.

Lastly, we have an opportunity to expand effective harm reduction efforts like naloxone distribution, syringe service programs, and spaces for monitoring and observation for people using drugs.

As the saying goes, we should “never let a good crisis go to waste.”  This was true in the formation of the United Nations, in the aftermath of the Great Recession, and now during the COVID-19 pandemic.  While the devastation COVID-19 has wrought is immense, we have also learned just how much we can collectively do to innovate and expand much needed care when lives are at stake. When we rebuild our public health system, let’s do it in a way that truly addresses structural racism and meets the needs of people who use drugs.

Now is the time to translate that same energy and passion into creating a health care system that can truly address the addiction and overdose crisis.

Dr. Sarah E. Wakeman is the Chief Medical Officer of RIZE Massachusetts Foundation, Medical Director of the Massachusetts General Hospital Substance Use Disorder Initiative and an Assistant Professor of Medicine at Harvard Medical School.