Charleston – West Virginia experts on addiction say another crisis looms over the COVID-19 pandemic.
Dr. Jim Berry, chair of behavioral health at West Virginia University, worries that as people in isolation turn to alcohol and drugs to cope, mental health care and substance use disorder treatment providers aren’t equipped to handle an increase in overdoses and new patients seeking help.
West Virginians keep hearing predictions about a surge in COVID-19 cases, Berry noted. The Institute for Health Metrics and Evaluation, a research center at UW Medicine, part of the University of Washington, predicts that 487 West Virginians will die of COVID-19 complications by Aug. 4.
West Virginians haven't been hearing about an upcoming surge in addiction, Berry added.
"And we're going to see more overdoses," he said. "We're going to see more suicides. And we're going to see more infectious disease because of this crisis and people who are going to be returning to their substances to try to deal with this anxiety and this fear that exists right now.
"People are going to suffer from trauma. They're going to suffer from grief as they see other people die. And they're going to suffer from addiction."
For years, West Virginia has had the highest rate of overdose deaths in the country. Last year, nearly 1,000 West Virginians died from overdoses.
Berry noted that during the COVID-19 crisis, addiction and mental illness don't go away.
"Quite the contrary," he said. "It's going to be exacerbated because people are going to be afraid and people are going to be isolated. And fear and isolation are going to drive addiction. It's just the reality, and if we don't pay attention to this, and we don't take this as seriously as our physical health problems, then we are going to find ourselves in an even worse state of despair than we were before. And it's going to be tragic."
He said that West Virginia’s behavioral health system was already undervalued, providers were already understaffed and mental health workers were already poorly paid. He also noted that because mental health affects physical health, placing more value on mental health and substance use treatment would reduce long-term physical health care costs.
On March 27, West Virginia's Alcohol Beverage Control Administration reported "an influx of out-of-state and in-state people purchasing liquor in West Virginia." National news outlets have reported that alcohol sales have increased nationwide.
"People have a lot of downtime, a lot of alone time, and a lot of time that they just don't know what to do, and they'll turn to drinking, and then that's going to put them at risk," Berry said. "You're going to decrease your immune system the more you drink, and also you're going to put yourself at risk to not be careful with your typical sanitary procedures if you're drinking too much."
While he urged people not to use drugs, he also reminded people who use drugs and alcohol to practice social distancing, practice frequent hand washing or use hand sanitizer if soap and water aren't available, and wash areas of skin that may be contaminated by drug supplies, such as skin over a vein.
DHHR rescinds memo
The West Virginia Department of Health and Human Resources sent a memo to addiction treatment providers Monday, advising them to halt new admissions to residential treatment facilities.
Meanwhile, nursing homes were still taking new patients.
DHHR rescinded that memo Thursday after criticism.
Berry worries that during the few days it was in effect, people in need of treatment did not receive it. He said a number of treatment providers reached out to him "expressing grave concern that people would fall through the cracks, and treatment programs would be left unable to serve people who desperately need treatment during that time," he said.
"There were a few treatment providers in the state that have reached out to me expressing grave concern that they would have to be shut down if this freeze was in place for 14 days or longer," he said.
In an email, Allison Adler, DHHR spokeswoman, said the memo was rescinded because "sober living facilities and the recovery homes informed us they are not going to ban admissions so individuals have the ability once they complete residential treatment services, they are able to step down to recovery community providers."
Berry said WVU had told DHHR that its residential treatment workers were already making changes in response to COVID-19, including no longer putting two people in one room, limiting visitation, increasing cleaning and practicing social distancing.
He said those at DHHR "although well-intended were probably overreaching in the sense they would disrupt much needed treatment for addiction."
"There are a number of various treatments that are done within a community, such as nursing homes, such as skilled nursing programs and physical rehab programs," Berry said.
He added that he had "no clue as to why this particular treatment was singled out as something unique."
Randy Venable, a licensed psychologist and chief clinical officer at FMRS Health Systems, a mental health care provider with locations in Beckley, Fayetteville, Union and Hinton, said during the time the order was in place, FMRS placed people they normally would have placed in residential treatment in a lower level of treatment, intensive outpatient treatment. That means patients still reside in their own homes but spend much of their time in treatment.
"You've got to meet people where they are and what they want to hear is that you're still willing to help them, and there's still help available, and we're going to figure that out," he said. "That's what keeps somebody engaged. We'd never start a conversation with 'we can't taken residential people right now.' The conversation's going to be 'let's figure out how we can help you."
At FMRS, people in intensive outpatient treatment are at FRMS "multiple hours a week, typically daily," he said.
Venable also thinks West Virginia may see an increase in addiction and overdoses. He added that FMRS is offering peer support virtually and by telephone.
"But with the increased anxiety that the whole world is under right now and some of the social isolation, I would say that's definitely a concern," he said.
Emergency calls level
So far, overdose calls in Raleigh County have not increased, Raleigh Emergency Operations Center Emergency Planner Cody Fortner said last week.
And HELP4WV reported last week that calls for referrals to addiction treatment had remained at pre-COVID levels. Brittany Shawver, director of the HELP4WV addiction hotline, said that she had seen little difference in the need for help, as measured by call volume. The line averages over 900 requests for help per month.
But Shawver added they "think call volume may increase as this continues, because unemployment, depression, and loneliness are all risk factors for addiction."
"We especially worry about overdoses increasing now that people are spending more time alone, and there may be no one else present to administer Narcan or call for help," she said.
West Virginia Gov. Jim Justice issued a stay-at-home order beginning March 24 to lower the risk of people spreading COVID-19 through social contact. Narcotics Anonymous and Alcoholic Anonymous meetings have moved online. A list of online meetings is available on the West Virginia Drug Intervention Institute website at wvdii.org.
But some of the most rural places in West Virginia lack high-speed internet.
HELP4WV has "retooled" its peer recovery support program, according to a news release.
"Normally, peer support specialists, who are themselves in long-term recovery from addiction, are out in the community leading support groups and meeting face-to-face with clients," the release stated. "Now, they are also available for support by phone or via telehealth. Anyone with a landline, computer, or mobile device can access support and advice from the peer coaches for free."
Those who want to be connected to a peer coach or learn about other treatment options can call the helpline 24/7 at 1-844-HELP-4WV or chat online at Help4WV.com
West Virginia has had two HIV outbreaks in less than four years. The second, which began in Cabell County but has since found its way into other areas, has spread to at least 140 people as of March 4, according to DHHR's website, and is tied to needle sharing. DHHR was updating that number bi-weekly but has not updated that number on its website for a month.
Harm reduction programs that provide clean syringes to people who inject drugs reduce the risk of HIV spread through needle sharing. Such programs also offer naloxone, which reverses opioid overdoses.
Cabell County began seeing fewer clients at its harm reduction program, which distributes clean syringes and naloxone, after it implemented new rules at its syringe exchange following political controversy over the needle exchange in Kanawha County.
At least two harm reduction programs in West Virginia have already had to scale back services as they allocate resources toward addressing COVID-19.
In an email Saturday, Beckley-Raleigh Health Department Administrator Candance Hurd said the health department's harm reduction programs "did meet the needs of our current clients. We provided syringe exchange and naloxone."
She did not respond to a question about whether there were any plans to discontinue services.
Dr. Clay Marsh, the state's coronavirus czar, said Friday he didn't know harm reduction programs were scaling back.
Emily Birckhead, executive director of the West Virginia Alliance of Recovery Residences, said her organization took a survey of recovery residences, which are not licensed treatment providers but do provide peer support for people with substance use disorder in West Virginia, and found that 60 percent of people who responded reported greater than 50 percent employment loss or reduction among their residents.
About 30 operators responded to the survey. Many of those oversee between three and 10 residences, she said.
Gov. Justice ordered all "non-essential" businesses to close March 24.
"People in recovery, especially early recovery, need a certain degree of structure in their day," Birckhead said. "Fortunately, many of our operators have found creative ways to continue to offer vital programming, like relapse prevention and life skills classes."
Birckhead noted that with local DMV offices closed, people also can't get ID they need to find new employment.
She also worried about the money recovery residences will lose if people in recovery can't pay to stay there. Recovery residence services are not covered by Medicaid.
And as West Virginians have rushed the grocery stories, some recovery residences are also having difficulty finding enough food and cleaning supplies.
Birckhead described the problem as "all the same challenges you and I face getting toilet paper and hand sanitizer, but multiply that by however many people you have in the house."
"The recovery community has always been, and will continue to be, incredibly resilient," she said. "The most important thing is to maintain the connections to recovery support systems, whether that be reaching out to friends, family, sponsors, or getting online and joining any of the hundreds of virtual meetings happening across the world. The best thing folks can do to support our recovery residences is to donate to their local programs, or to reach out to them and ask them if they need help with food or supplies."
Locally, people experiencing emotional distress or problems with substance use can contact FMRS. The number for Raleigh County is 304-256-7100. The number for Fayette County is 304-574-2100. The number for Monroe County is 304-772-5452. The number for Summers County is 304-466-3899.
FMRS typically serves low-income patients. Those who have not lost their jobs can also try private psychologists' and psychiatrists' offices, although their health insurance may not cover mental health counseling through telehealth.
Suicide is associated with mental health problems and substance use disorder, which can be treated. If you or someone you know is in crisis, call the Suicide Prevention Lifeline at 800-273-8255(TALK).
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