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Why Public Health Can’t Shelter in Place to Address Stimulant Use

April 24, 2020

Without a promising vaccine or treatment for COVID-19, everyone is learning to adapt to social distancing.

As daily life has changed, so too have regular public health meetings and gatherings. I recently attended the virtual Rx Drug Abuse and Heroin Summit, and while I couldn’t connect to other experts and community advocates in person, I was able to participate in a number of virtual events and catch some of Abt’s own experts, Nida Corry and Leigh Evans, who shared their work.

Holding the conference in the midst of the pandemic underscored the ongoing national importance of addressing opioid, stimulant, and other polysubstance use-- especially since substance misuse and substance use disorders (SUDs) don’t stop for a pandemic. Prevention, treatment, and recovery efforts must continue. So, too, must the focus on the intersection of SUD and other social determinants of health such as housing, job security, and criminal justice involvement—an approach we take at Abt.

Like COVID-19, substance misuse impacts all of us and every sector of society. And failure to prevent and prepare for public health challenges can quickly boil into crises. This is why many public health advocates are sounding the alarm about the need to plan and maintain linkages to behavioral health care while sheltering in place. Past large scale traumas such as hurricanes provide examples of how to develop programs to continue care in the face of extreme adversity. But now, the need for comprehensive policies and a national response is clear. What can we in the public and behavioral health fields do?

Increase access and rethink barriers

People need access to treatment and services. While technology like telehealth can solve some tough challenges, it doesn’t address everything. Take prescription laws. Physicians currently prescribe medication for opioid use disorder (OUD) after a patient has a physical exam. But COVID-19 doesn’t play by established rules, and it may be too dangerous for physicians to follow that practice. The good news is that some agencies are giving exemptions to physicians who prescribe buprenorphine, an evidence-based OUD medication, so that they can prescribe needed OUD treatment without a risky physical exam.

Likewise, we need to change requirements for who can pick up these medicines. Recognizing that individuals in opioid treatment programs might not be able to go to the program to pick up medication, the Substance Abuse and Mental Health Services Administration (SAMHSA) recently released guidelines to open up access to needed medications for OUD, including allowing home deliveries for those with COVID-19 symptoms. Similar approaches should be considered for Narcan; this may help save lives in light of decreasing treatment options for those with OUD.

These are good steps, but we have a long road ahead. SAMSHA, states, and other licensing boards could examine these new guidelines and consider granting additional exemptions. Organizations could expand home deliveries to people who don’t have COVID-19. Any changes will require evaluations to see if they are effective and to detect any unintended consequences.

Finally, we may all need to adapt, but it’s much harder for the most vulnerable. Sheltering in place can be easier with stable and safe housing, health insurance coverage, and access to phone and internet services. Many individuals and their families don’t have such access and resources. These barriers are not new. But this pandemic should prompt creation of a public health system that is better than the one we had before COVID and addresses the needs of people who are both vulnerable and underserved. This is an opportunity for all of us to rethink and change our approaches to SUD.

Agile thinking is critical now more than ever. Rates of substance misuse and SUDs, including polysubstance use, are rising. Alcohol rates are rapidly climbing, and there are growing fears of higher overdose rates during shelter in place orders. Additionally, many underlying chronic diseases and SUDs like smoking, opioid use, and polysubstance use put people at greater risk for poor health outcomes if they develop COVID-19. One crisis can reinforce another.

We may be living in an unprecedented time, but we have overcome difficult challenges before. What matters most is how we adapt. We must foster openness to new possibilities--even ones we couldn’t imagine just a few months ago. This spirit can promote the collaboration needed to build strong, comprehensive health care practices, systems, and societies. It’s the resilient spirit that calls many of us to work in behavioral health and other health and public policy fields in the first place. Public health will adapt and learn from COVID. People must shelter in place. The push to adapt policies and improve our public health system can’t.

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