The restrictions imposed by COVID-19 have put the community of substance users under severe duress.
In the last few weeks, I’ve lost two patients of mine at the primary care clinic in Charlestown, Massachusetts, where I work as a physician. But I didn’t lose them toJames had been in remission for months from substance use disorder and was helping to take care of his first grandchild. He had been an ironworker for decades, building our fancy Boston skyscrapers, and was stable enough to undergo surgery for the chronic low back pain stemming from his job.
When it happened a third time, we diagnosed relapse of his substance abuse disorder and transitioned him to medication-assisted treatment. We recommended buprenorphine, which would help manage his pain and cravings, but James declined, citing his previous bad experience with it ― in his case, he got depressed. Instead, James opted for methadone, which he would have to obtain by visiting a clinic on a daily basis.; as a lockdown measure, methadone clinics were closing their doors to new patients.
Although I am a primary care physician, I regularly deal with substance use disorder . It was not part of the training in my field until recently. Now we’ve got much more support, training and experience with helping this type of patient overcome their challenges., which involves recommendations to mitigate the worst outcomes of drug use. But substance use recovery and harm reduction are social by nature, and COVID has complicated our work.
On top of managing their disorder, many of my patients are out of work and can’t meet basic needs like housing and food, which is only partly mitigated by a stimulus check. Many live in overcrowded housing, and some families are allowing loved ones to use drugs at home to keep them off the streets and thus avoid COVID-19 exposure.has been providing naloxone to as many families as possible to decrease the risk of overdose.
, a national advocacy organization has created guidelines for safer drug use during the pandemic, stressing the need to minimize the sharing of supplies, wiping mouthpieces with alcohol , and having a breathing mask on hand in case rescue breathing is necessary The guidelinesThe same day my team was grieving James’s death, we got tragic news about a patient, Mary, with whom I’d worked for years to get off heroin and regain custody of her three boys.
James and Mary represent an epidemic within the pandemic. While social distancing is critical to flattening the coronavirus curve, for more stigmatized and vulnerable populations like those with substance use disorder, it can also be very dangerous.
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