This blog post is the second of two taken from a recent Webinar featuring Jill Warrington, MD, PhD., Chief Medical Officer, Aspenti Health and Assistant Professor, Robert Larner College of Medicine, University of Vermont.
The COVID-19 pandemic presents a unique set of challenges for substance use disorder (SUD) patients—in this webinar Dr. Jill Warrington defines those challenges and presents recommendations on how SUD patients can be supported through the pandemic.
Virtually everyone has been challenged by the pandemic; however, Warrington points out that SUD patients face some unique challenges.
First, SUD patients have physiological vulnerabilities that make them more susceptible to the virus. Most of the physiological vulnerabilities to COVID-19 are a result of organ damage resulting from drug use. Pulmonary injuries frequently occur when patients smoke (COPD), vape (“Popcorn Lung”), use opioids (Respiratory Depression), or use methamphetamines (Lung Injuries). In addition, methamphetamine use can result in cardiomyopathy, IV drug use may injure heart valves, and opioid use can trigger immune dysfunction; leaving this population particularly vulnerable to the virus.
Secondly, Dr. Warrington has also identified numerous social determinants of health that leave this population particularly vulnerable in this pandemic. The social determinants for this population range from homelessness to disparities in healthcare access and insurance. Warrington points to incarceration as being particularly problematic. Somewhere between 30% and 50% of the incarcerated population have some sort of substance abuse issue—with little chance to social distance they are left vulnerable to the virus.
Warrington cites a New York Times article that referred to the pandemic as a “relapse trigger.” In addition to the characteristics of their illness and the physical consequences of drug dependency putting them at risk for COVID-19, the virus can also exacerbate SUD and put them at risk for relapse. Warrington describes SUD as a disease of social isolation. “Social networks are our patients’ lifeline in continuing their path to recovery,” says Warrington. She is concerned that social distancing is re-immersing SUD patients into the environments from which they came which can result in exposure to relapse triggers. In addition, using drugs while alone carries additional risk as no one is available to intervene in the case of an accidental overdose. Social isolation can exacerbate other mental health conditions, particularly anxiety.
The pandemic has created the perfect environment for a global behavioral health crisis. Traditional models for treating this population are not currently options for providers, so what can we do? Warrington has five suggestions to implement now:
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