Redesigning Addiction and Recovery Services in a COVID-19 World

It is abundantly clear that COVID-19 will result in fundamental changes in how societies around the world function. We can all sense this demarcation of a fundamental change in our own lives and communities. It will take years to fully understand all of the ramifications of how this will impact our lives and all of our societal institutions, but it is not too early to consider what this crisis can teach us the importance of addressing substance use in a comprehensive, long term, recovery focused model.

We face significant challenges moving forward, but with those challenges also come opportunities to reshape our institutions and redesign how we address societal problems more proactively, including our substance use service system. The pandemic has shown us that acute care models of addressing addiction are woefully inadequate to properly address these complex challenges. It is clear that drug use, addiction and recovery are areas ripe for refocusing and redesign. Failure to address them fully exacerbates COVID-19 and other medical conditions.

We need to get a whole lot better at addressing multifaceted substance use care in a more systemic recovery-oriented fashion. This becomes clear in a recent interview, Dr Nora Volkow, Director of the National Institute on Drug Abuse. She characterized vaping as an epidemic and also noted that we are seeing a dramatic increase in overdoses, and framed it as a second epidemic. This also creates additional challenges in respect to treating COVID-19 which she considered the third epidemic. Dr. Volkow noted that opioids are immunosuppressants and depress respiration which may increase the risk of death from COVID-19. She also states that nicotine can disrupt immunity and impair the capacity of the cell to respond to viral infections. People who suffer from the disease of addiction are particularly vulnerable to both catching the coronavirus and having a more severe disease when they do catch it.

We should also pay attention to alcohol related deaths, which have been steadily increasing in recent years across the US.  As COVID-19 spread, we saw a dramatic increase in alcohol sales across the county in recent weeks. Job losses and the impact of physical isolation and other COVID-19 related stressors may well result in a long-term increase in deaths from alcoholism across the United States. We could call this our fourth epidemic and the increasing rate of suicide our fifth epidemic. Suicide is far too often also associated with substance misuse and addiction.

While these challenges are formidable, they present an opportunity to innovate and redesign care that meets our needs more comprehensively. In respect to vaping, Dr Volkow notes that it makes sense to caution people about the risks of vaping and to work to support more comprehensive care as we are dealing with complex, multifaceted issues. This is true for all addictive drugs across our whole substance use care system. As Dr Peter Grinspoon noted in his Harvard Medical School blog post a few days ago, “We need to factor in these considerations on our substance use treatment and recovery support service care models for them to be more effective and save even more lives and resources.”

The lesson here is that while we do not yet fully understand COVID-19, we do understand that people dealing with substance misuse issues are at a greater risk from this deadly virus. We need to provide SUD treatment and recovery support services not as an acute care, single drug-oriented intervention, but inclusive of all addictive drugs the person is using as part of a long term, recovery focused model.

As we look at redesigning our substance use care systems, we should be well aware that not only is recovery possible, but it is the probable outcome given the proper services and support. We must  redesign our care system in ways that support long term recovery inclusive of all addictive drug use. The question all policymakers should focus on establishing care that gets people into and sustains recovery to the point of five years, at which time 85% of the people will remain in recovery for the rest of their lives.

It is a hard time in America, perhaps the hardest time in modern history. It is apparent that we are in the early stages of dealing with COVID-19, and that interventions in this area will be measured in months and years and not days or weeks.  It is not too early to think about how we innovate our care systems to meet these challenges. One thing we really are good at in America is innovation. Let’s take action now to begin addressing addictive drug use and recovery in a more comprehensive long term, multifaceted fashion as a major element of saving lives and improving health in America.