What the Pandemic Teaches Us About the Need for MAT
Medication-assisted treatment, a life-saving practice, is needed more than ever.
Posted Nov 03, 2020
From the economic repercussions associated with COVID-19 to its mental health toll, the pandemic’s impact is undeniable. With breaking news updates largely focused on the coronavirus, another epidemic that is wreaking havoc across the U.S. has taken a backseat: the opioid crisis. Accelerated rates of drug use in 2020 are highlighting the increased need for efficacious treatment solutions.
The Opioid Crisis: Then and Now
The opioid epidemic has been devastating the nation for years, long before the onset of COVID-19. In 2010, opioid overdoses claimed 21,088 lives across the country; the National Institute on Drug Abuse (NIDA) found that this number more than doubled to 47,600 in 2017. As of 2019, opioid overdoses reportedly comprised 50,168 of the 71,125 total drug overdose deaths, according to the Centers for Disease Control and Prevention (CDC).
This year, the number of lethal overdoses continues to climb. The CDC estimates that 19,416 Americans suffered a fatal overdose in just the first three months of 2020, indicating a 10 percent rise in deaths compared to the previous year. Another cause for alarm is a report by the American Medical Association signaling that over 40 states have seen a rise in opioid-related overdose deaths since the start of the pandemic. If the nation does not act quickly, the CDC predicts that 75,500 Americans will lose their lives from drug-related causes by the end of this year—on top of the immense death toll from the coronavirus.
A Perfect Storm for Those Struggling With Opioid Addiction
The increase in overdose deaths leads many in the treatment industry to likewise fear surges in the overall rate of substance use and mental health disorders. In abiding by recommendations for social distancing, Americans are feeling increasingly isolated from their social circles, with many unable to see their parents, friends, and children in person. Under these stressful circumstances, treatment professionals anticipate that more Americans will self-medicate with opioids, alcohol, and other substances rather than utilizing healthy coping techniques to manage life’s many pressures.
Another issue that continues to contribute to the high overdose death toll is the prevalence of fentanyl, a synthetic opioid 50 times more potent than heroin. Often, those who use heroin and other opioids do not realize that their supply has been laced with fentanyl, while many other users are actively seeking out fentanyl due to the powerful high it produces.
Naloxone (offered under the brand name Narcan) can be used to successfully reverse an opioid overdose, but multiple doses may need to be administered to a person who has overdosed on fentanyl. And Narcan, of course, is not an adequate long-term solution for coping with opioid addiction.
How to Manage Opioid Use Disorder in the Shadow of a Pandemic
Opioid use disorder is a chronic illness, but it can be managed. First, it is crucial to get people suffering from it into treatment, so they can receive counseling, build a support network, and develop key sober coping skills. Those struggling with opioid addiction may especially benefit from medication-assisted treatment (MAT). This option has not only been shown to support ongoing recovery, it can also save lives. It is a form of treatment that utilizes addiction medications, such as buprenorphine and naltrexone, to help individuals better focus on their sobriety.
A 2020 investigation published in JAMA Network Open studied over 40,000 patients with opioid use disorder and found that those who received buprenorphine were 76 percent less likely to experience an overdose three months after being treated. They also had a 32 percent lower chance of requiring acute medical care during the same time period.
The use of addiction medications to treat opioid use disorder is even more effective when combined with clinical programming, which encourages patients to better understand the roots of their addiction while forming positive coping skills to support their recovery.
Despite good evidence for MAT, the practice of using medications to treat addiction is often the victim of skepticism, stigma, and derision. Specifically, buprenorphine, a partial agonist for the mu-opioid receptor, is dismissed by some as “substituting one drug for another.” But when taken as prescribed, buprenorphine binds to and blocks the opiate receptors, diminishes risk of any withdrawal symptoms, and—as I’ve been told by many clients—“takes the cravings off the table.” With cravings under control, people suffering from addiction are better able to focus on the hard work of treatment: gaining an understanding of themselves and factors that drive their addiction, learning new sober coping techniques, and repairing the damage done to their bodies and the important relationships in their lives.
Due to both government regulations and societal stigma shared by some providers regarding the nature of addiction, healthcare centers that offer MAT can be difficult to find. A 2019 study in the journal Health Affairs revealed that only 36 percent of substance use treatment facilities in the U.S. provided addiction medications as part of their programming in 2016. During the pandemic, many providers have found it even more challenging to offer MAT. Monthly injections of extended-release forms of both naltrexone (Vivitrol) and buprenorphine (Sublocade) are often the most effective treatments because they don’t require daily administration and there is no risk of diversion. But, obviously, one can’t provide injections during a Zoom appointment.
Addressing Two Epidemics
Before COVID-19 struck, opioids were killing 130 Americans each day. And now, with the current autumn surge in coronavirus cases, we are seeing as many as 1,000 Americans dying each day from this new pandemic. But there are things we can do. To fight COVID-19, we can follow CDC guidance on masking, social distancing, and avoiding large gatherings. For combating the opioid crisis, we can embrace evidence-based treatment options like MAT and work to increase access to treatment for those suffering from opioid use disorder.
We cannot become numbed by the devastating climb in numbers and statistics we are seeing. Tragedy is often preventable. Improving access to and knowledge of medication-assisted treatment can help to ensure that vulnerable populations receive the care they need during one of the deadliest periods in the country’s history.
Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020.
Johns Hopkins Bloomberg School of Public Health. (2019, January 15). Fraction of U.S. outpatient treatment centers offer medication for opioid addiction [Press release]. https://www.jhsph.edu/news/news-releases/2019/fraction-of-us-outpatient-treatment-centers-offer-medication-for-opioid-addiction.html
National Center for Health Statistics. (2020.) Percent of drug overdose deaths by quarter and demographic characteristics: United States 2018-Q1 through 2020-Q1. https://www.cdc.gov/nchs/data/health_policy/Provisional-Drug-Overdose-Deaths-by-Quarter-Demographic-Characteristics-Q1-2020.pdf
National Institute on Drug Abuse. (2020). Overdose death rates. https://www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates
Reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic [Issue brief]. American Medical Association, Advocacy Resource Center. https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf
Wakeman SE, Larochelle MR, Ameli O, et al. (2020.) Comparative effectiveness of different treatment pathways for opioid use disorder. JAMA Netw Open 3(2). https://doi.org/10.1001/jamanetworkopen.2019.20622