While the COVID 19 pandemic is a global health crisis in its own right, the lockdowns and restrictions surrounding it have caused other, smaller scale health crises – including a revival of the opioid epidemic in America. After years of gains in reducing overdose deaths, numbers are back up again. Poor and rural areas that have seen hospital closures and dwindling healthcare access have been particularly hard hit. But an initiative from Texas A&M University aims to better equip doctors and mental health providers to deal with opioid use in their communities.
Dr Dheeraj Raina is a psychiatrist specializing in addiction medicine. On a recent Zoom call, he spoke to more than 40 doctors, counselors and students about a concept in behavioral health called the “stages of change,” and how it relates to substance use disorders.
“We have to recognize that progression through stages of change is not linear, not guaranteed and not time bound,” he said. “Meaning that individuals do not go in a steady fashion from pre-contemplation to preparation to maintenance. They will frequently bounce back and forth.”
The lecture is part of a new initiative from Texas A&M Health Science Center called the Empower TeleEcho program. It’s a series of free webinars for healthcare providers who want to learn more about helping patients with substance use issues – which experts say have increased dramatically during the pandemic. The goal of the program is to connect medical professionals to experts in addiction care.
“It’s mentoring health care providers in rural areas who may not have the knowledge or expertise to care for patients with certain conditions,” said Chinelo Nsobundu, the program manager for the Empower initiative.
Each session starts out with a 30 minute lecture on a topic relating to best practices in treating substance abuse disorders, like addressing stigma around addiction, or how opioid use presents in adolescents. Then, presenters discuss a case study featuring real patient scenarios and answer questions about treatment strategies.
“The providers are able to provide some kind of mentorship or guidance in terms of what that health care provider can do to treat and manage this particular individual that they may not have been doing in their clinical practice,” Nsobundu said.
The program kicked off at the beginning of the year, with financial backing from the health insurance company Amerigroup. The timing isn’t coincidental. Substance abuse – and opioid overdoses in particular – have been on the rise in the past year.
“The number of both fatal and non-fatal overdoses due to opioids has dramatically increased in Texas and in the United States,” said Dr. Joy Alonzo, cochair of Texas A&M’s Opioid Task Force, which oversees the Empower program. “This has been one of the most concerning phenomenons, as a public health issue, that we’ve noticed since the pandemic started.”
Opioid overdoses were trending downward between 2016 and 2019. Then came COVID lockdowns.
“We were making a lot of headway,” Alonzo said. “And then when the pandemic hit all that ground to a halt and people were not able to access care, people that have substance use disorders were not able to go to their practitioners.”
According to provisional data from the Centers for Disease Control, opioid overdose deaths in 2020 rose nearly 30% over the previous year. More than 90,000 people died of overdoses last year – the highest number on record.
Factors like social isolation and lack of access to care during the pandemic likely contributed to the spike, “so when folks don’t get the psychosocial supports that they need, and they don’t have that community around them, they tend to relapse. It’s very, very impactful to their state,” Alonzo said.
Some general practitioners who don’t specialize in addiction treatment may not feel equipped to navigate the challenges of treating substance use issues, Alonzo said. Perhaps they simply don’t come across the issue very often. That’s where connecting with trained addiction medicine specialists through the Empower program can help.
“This may be the first time since they went to medical school that they’ve actually had any access to an expert in these particular treatment areas,” Alonzo said. “So we want to make sure that that anybody who wants to provide treatment has the tools that they need as a family practitioner or a nurse practitioner”
One person who has already benefited from the sessions is James Mazza. He’s community coalition coordinator for the Waco-area nonprofit Voice, which focuses on wellness education for youth and their parents, including educating about drug abuse.
Mazza said that overdoses in the Waco area have more or less kept pace with national trends – rising about 25 percent since the pandemic began. He also said that lack of access to care was a big driver. With doctors and hospitals stretched thin with COVID cases, appointments for pain management became harder to come by.
“People have lost access to their doctors, so they’re not able to actually access pain medication or receive pharmacological advice,” he said. “And so people that have developed an addiction to pain medication are having to turn to street drugs and the synthetic opioids.”
Mazza said one of the biggest roadblocks to addressing opioid abuse in his community is the stigma around the condition.
“I think a lot of what you’re seeing in Waco is people don’t think that ‘good people,’ and I’m putting this in air quotes… but ‘good people’ don’t get addicted to medications, and that’s just flat out not true. Anybody can get addicted to them,” Mazza said.
That can make people afraid of admitting they have a problem or seeking help. So dispelling the stigma is one of Mazza’s top priorities. He said that participating in the A&M program has helped him better understand how other communities are dealing with opioid use.
“It’s a great way to share information on how other people are treating problems in their community,” Mazza said. “Especially if it’s something like, you know, Waco is not necessarily a large community, but it’s not a small community, either. So there are some things that we have seen, but maybe not in as depth or as an intense as somebody who is from Austin or Dallas”
Alonzo, with the Opioid Task Force, said that ongoing education and improved treatment options in parts of the state outside major urban centers is key to supporting those struggling with opioid use, and to reversing the rise in overdoses brought on by the pandemic.
“It’s a war every day for these folks. Every day they have to recommit to staying in recovery. And without that supportive community, it’s very difficult.”
Texas A&M Health Science Center’s Empower TeleEcho program is free of charge and any healthcare providers, pharmacists, and mental health professionals in Texas are able to attend.