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Coronavirus A 'Perfect Storm' For Current And Former Drug Users In St. Louis

Missouri Network for Opiate Reform and Recovery Executive Director stands beside the nonprofit's mobile outreach van. The decal on the back window represents the molecule naloxone, a chemical that can reverse and overdose.
File photo | Sarah Fentem | St. Louis Public Radio
Chad Sabora, executive director of the Missouri Network for Opioid Reform and Recovery, stands outside the organization's mobile outreach van. The COVID-19 outbreak has decreased the amount of outreach the nonprofit can conduct.

On most days, workers from the Missouri Network for Opiate Reform and Recovery meet with clients at the addiction treatment center’s South Broadway storefront location or hit the streets to distribute naloxone and clean syringes to people using drugs.

But this week, the organization paused in-person meetings and decreased street outreach as the organization tries to balance protecting its staff from the spread of the coronavirus with its mission to support those currently and formerly addicted to drugs.

With many people isolated during the pandemic, those with addictions are at greater risk for relapse and overdose.

The COVID-19 outbreak has “made an already impossible job even more impossible,” said Chad Sabora, the network’s founder and executive director.

“During this time we are going to see a spike in overdose deaths, we will definitely also see a spike in hepatitis C and HIV,” he said.

People in recovery from alcohol or drug addiction often find the support they need in peer meetings and support groups at places like the network. But government-imposed shelter-in-place orders intended to stop the spread of the virus have meant people can’t see each other. Limits on how many people can gather in one place have put meetings on hold.

Some inpatient recovery centers also have stopped accepting new patients to protect their current clients and staff members. 

The network’s headquarters is still open, but staff needs to let visitors in, and everyone needs to stay six feet away from each other, Sabora said. Recovery groups are also meeting using video conferencing, and workers are doing more telephone consultations.

A sign outside the Missouri Network for Opiate Reform and Recovery advertises Narcan, a medication that can reverse an opioid overdose.
Credit File photo |Carolina Hidalgo | St. Louis Public Radio
A sign outside the Missouri Network for Opiate Reform and Recovery advertises Narcan, a medication that can reverse an opioid overdose. The organization has had to quickly adjust its efforts to keep its staff safe from contracting the coronavirus.

That can be rough on those who depend on in-person support to stay sober, he said.

“That face-to-face interaction, that hug, that room full of people going through the same thing all carries such a different dynamic,” Sabora said. “Doing it via the internet is not as effective at all.”

Not being able to leave home could put others at risk for relapse, said Percy Menzies, president of the St. Louis-based Assisted Recovery Centers of America.

“We know the two strongest factors that contribute to relapse are boredom and loneliness, and when you’re sheltering in place, you’ve got plenty of that,” he said. Adding lost income from a coronavirus-related job loss creates “the perfect storm” for people with addiction, he said.

ARCA has seen a roughly 30% increase in telemedicine calls over the past few weeks, Menzies said. Many people who were doing well have seen their addiction problems flare up in response to stress caused by the disease outbreak.

“This morning, I got about eight calls, including a call from a patient who had done very well in the past,” Menzies said Wednesday. “Now he says with the stress and anxiety of what is happening, his cravings had come back very strong for alcohol.”

Menzies encourages those who are at risk of relapse to call recovery clinics, which may be able to prescribe anti-addiction medications over the phone.

Recent regulatory changes are helping increase access to treatment, he said.

Last month, the federal government announced the loosening of several restrictions on treatment providers. Patients can now take home two or four weeks of methadone, which is usually dispensed daily at special clinics.

The federal Substance Abuse and Mental Health Services Administration has also waived requirements that doctors see patients in person before prescribing the opioid addiction medication buprenorphine. Missouri Opioid Response has compiled a list of state providers that are conducting telemedicine consultations for those seeking treatment.

But telemedicine leaves out many people who don’t have a place to live, said Rachel Winograd, associate research professor at the University of Missouri-St. Louis’ Missouri Institute of Mental Health. Many people who use drugs are transient or homeless and don’t have internet access.

“In reality, we have yet to see how this will play out in terms of access," she said. “And of course we need to mourn the loss of in-person services, which …. provide a lot of community and social connection and friendship and hope and things that people in various stages of drug use and recovery really want and need.”

Treatment providers are exploring new ways to reach people. For example, Sabora’s organization is talking to local food delivery services about potentially bringing naloxone along with food, he said.

Follow Sarah on Twitter: @petit_smudge

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Sarah Fentem is the health reporter at St. Louis Public Radio.