A devastating combination

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As Monroe County battles a sharp rise in COVID-19 cases, drug usage is creeping up. Though data continues to trickle in, initial observations signal an epidemic within a pandemic.

“People go (to) what they know and what makes them feel good, which is drugs,” says Gloria Baciewicz M.D., senior medical director of the University of Rochester Medical Center’s Strong Recovery program.

As a result, some local programs that treat drug and alcohol abuse or dependency, also called substance use disorder, have seen their patient population grow in recent months. 

While the increase could indicate that more in the area are recognizing their need for treatment, fatal overdoses also have risen in Monroe County since the pandemic struck. The Monroe County Heroin Task Force, a part of the Monroe County sheriff’s office that monitors all overdoses involving opioids, reports that such drugs contributed to the deaths of 120 people in the county from January to November. That’s a 3.4 percent increase over the same period in 2019. As of Dec. 3, three more people had died as a result of overdosing.

Treatment providers say increased use of the synthetic opioid fentanyl has contributed to the death toll.  

“What we have seen over the past five years is fentanyl sneaking up, up, up,” says Jennifer Faringer, director of the National Council on Alcoholism & Drug Dependence-Rochester Area.

A fertile environment

The coronavirus pandemic has created fertile conditions for the spread of SUD, in part through its effects on mental health. Of more than 5,400 adults across the U.S. who were surveyed in June, almost 41 percent reported suffering adverse mental health or behavioral conditions as a result of the pandemic, including symptoms of anxiety and depressive disorders, and of trauma and stressor-related disorder. 

An appreciable number of those surveyed in June felt that drugs or alcohol could offer a measure of relief for coronavirus-related stress. More than 13 percent reported that they’d dealt with that stress by using or increasing their use of substances.

Since the pandemic hit the Rochester area, some SUD treatment providers have treated more patients for opioid abuse and dependence than before.

Azfar Ahmed

“It’s really street heroin, which has been mixed or adulterated with fentanyl,” says Azfar Ahmed M.D., medical director of Clifton Springs Hospital and Clinic’s inpatient and outpatient addiction recovery programs. 

The combination can prove fatal. Heroin is up to five times more powerful than morphine, the naturally occurring drug from which it is made. In contrast, fentanyl can be up to 100 times more potent. The synthetic opioid is also readily available for illegal sale locally and cheaper than other drugs in its class. Dealers like to raise their profits by mixing itwith more expensive drugs.

“If you add a bunch of cheap fentanyl to a quantity of heroin or cocaine or methamphetamine, you end up stretching it out, and possibly making more money,” Baciewicz says. 

Fentanyl’s greater potency makes the combination more deadly than drug users may realize. Despite that, dealers might not reveal that the synthetic is part of the mixture they’re selling.

“All of a sudden, your dealer starts selling you heroin that has a high amount of fentanyl,” Baciewicz says. “You may take the same amount that you needed before to get high, but the amount of the heroin plus the fentanyl may be enough to kill you.” 

The combination has helped drive up overdose numbers around the country for years. From 1999 to 2018, 750,000 people died from overdoses, nearly 450,000 of them from the use of prescription drugs like the opioid Oxycontin or illicit opioids like heroin and fentanyl. Overdoses fell in 2018 due in part to the imposition of new federal guidelines for the prescribing of Oxycontin, then began picking up again. A projected 70,980 Americans fatally overdosed in 2019, almost 5 percent more than the previous year, according to the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics.

Increasing numbers

Drug overdoses have continued to increase in the U.S. even while the pandemic has ravaged the country. The number of people suffering overdoses rose by 18 percent in March, 29 percent in April and a whopping 42 percent in May, when compared to those months in 2019. Altogether, nonfatal overdoses rose by nearly 18.6 percent during that period, and fatal overdoses by 11.4 percent, research published in Population Health Management found. 

In some ways, the coronavirus pandemic has been a double-whammy for those who are prone to use drugs or alcohol, increasing their stress while cutting them off from the normal pursuits they once depended on. Socializing with clean and sober friends, burning off tension in the gym and relaxing in social settings and even heading off to work to get out of the house has become difficult or impossible. As a result, all too many are turning to alcohol or drugs.

“What are they going to revert to? What they know,” says Monroe County Sheriff’s Deputy Michael Favata, a member of the Heroin Task Force. 

At the same time, the risk of contracting coronavirus is discouraging those battling substance use disorder from seeking the help they need. 

Jennifer Faringer

“Being honestly afraid to go to any appointment … has been an issue during COVID,” Faringer says. 

For that reason, some treatment programs initially found fewer people coming to them for care. At Clifton Springs, the SUD programs saw patient numbers drop from March to August. 

“There was a great concern in the community of contracting the virus in a hospital setting,” Ahmed says. 

His programs took in only 26 people in April. Before the pandemic, an average of 50 people per month were admitted. 

Greater Rochester’s SUD treatment programs and facilities quickly changed their operations in an effort to cope with the pandemic. In March, Strong Recovery began providing most treatment remotely.

“We had to cut down on the number of groups offered, and we offer those groups partly by Zoom and partly in person,” Baciewicz says.

Those receiving methadone replacement therapy are now given multiple doses of the drug when they come in, instead of the single doses they received pre-pandemic, in order to reduce their contact with staff and other patients. Methadoneblunts or blocks the effects of opioids, reduces craving for the drugs, and decreases the withdrawal symptoms that users experience when they stop taking opioids.

Offering help

Treatment providers and law enforcement personnel are working together to combat the spread of SUDs, prevent overdoses and bring those suffering from the disorder to treatment. Favata meets with the victims of nonfatal overdoses within 24 hours and tries to help them get into treatment programs.

“I will take them right down to treatment,” he says. “We want to keep people off of the drugs.” 

Helio Health operates SUD treatment facilities around Upstate New York, including a 40-bed Rochester facility that offers medically supervised drug/alcohol withdrawal and inpatient care. The nonprofit has taken several steps to reduce the risk of spreading coronavirus.

“You might be doing some things through telehealth between yourself and a person in the next room just to minimize how much time we’re spending in direct contact with each other,” says Helio Health president and CEO Jeremy Klemanski.

Such measures have helped local treatment providers continue to serve those in need of care. The number of patients in Clifton Springs’ SUD programs has inched upward since August, and reached 34 by the end of October. Strong Recovery has continued to log new patients during the pandemic.

Gloria Baciewicz

“We’re definitely filling up our intake slots,” Baciewicz says.

As a result of the safety measures it established, Strong Recovery was able to start seeing a limited number of patients during the summer.

“There were certain groups of people that just didn’t do well in the Zoom groups, and they wanted to come in in person,” Baciewicz says. “We wanted to have some options for them.”

Overall, the shift to remote treatment has been a plus for Strong Recovery in a number of ways. 

“We have people coming in for methadone from outlying counties,” Baciewicz says. “This way, we can do some of their visits via Zoom or telephone, and this is a big boon for them.”

The shift to remote has also made patients easier to reach. 

“It increases our rate of being able to contact them, and decreases our no-show rate,” Baciewicz says.

Jeremy Klemanski

Klemanski says more and more people have been coming to his Rochester facility for treatment. In the past few months, Helio Health’s programs have been operating at 70 percent to 92 percent capacity.

“That’s really strong utilization for these types of programs,” Klemanski says.

While the measures that treatment facilities have taken appear to be working well, remote treatment is not ideal for those trying to recover from SUDs, particularly when many are already isolated because of the pandemic.

“Isolation is not good for someone in recovery,” Faringer says. “The impact of further isolation on their addiction and their struggle only makes it worse.” 

The virus has also made it more difficult for those diagnosed with SUDs to reach out to organized, recovery-oriented groups for the support they need.

“The things we ask people to do to get into recovery, such as go to treatment, maybe go to some self-help groups such as Alcoholics Anonymous and Narcotics Anonymous, those things become more difficult in the COVID-19 era,” Baciewicz says.

Participation in AA, NA and other self-help groups helps those who have SUD stop using drugs or alcohol and stay in recovery. Unfortunately, 28 of the 45 AA groups and 10 of the 28 NA groups that meet in the Rochester do so only virtually, and some patients might not have access to computers, the internet or cell phones.

Mike Costanza is a Rochester Beacon contributing writer.

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