N.H. Addiction Treatment Providers Say Pandemic Poses New Challenges...And An Opportunity
Many once face-to-face interactions have moved online during COVID-19, including for people who are in recovery from a substance use disorder.
But the pandemic has also introduced challenges to providing treatment in a time of social distancing.
Laura Byrne has been spending more time driving around the Upper Valley these days.
She’s been meeting clients for a mobile syringe exchange. With COVID-19, the organization Byrne leads - the HIV/HCV resource center - had to ramp up its mobile services.
Clients exchange needles or syringes they’ve already used to inject drugs. Byrne, in return, gives her clients a bag with clean tourniquets, needles, alcohol wipes, fentanyl test strips and naloxone, which is used to reverse overdoses.
She’s also added a few other things:
“Now we’re including hand sanitizer, and information on COVID-19 as well,” she said.
She and her team also talk about what the symptoms of the disease are: dry cough, fever, difficulty breathing - and what social distancing means.
“People are happy to have clean supplies. I think as this goes on, it’s hitting people, including our clients more and more about the severity of the situation,” she said.
COVID-19 has highlighted long-standing concerns and limitations of the existing substance use treatment system in New Hampshire. And restrictions put in place because of the pandemic have made things more complicated for service providers to connect with people who are still looking to find treatment.
Especially when a lot of treatment is happening through video or phone calls these days.
“Many don’t have homes or a safe, confidential place to even sit to have this interaction. So then it’s how do we get them set up with that?” said Pete Fifield, who runs the Doorway at Wentworth-Douglass Hospital in Dover.
It’s part of a state program that helps refer people with substance use disorders to treatment options near them.
To help connect people who are seeking treatment through the Doorway, Fifield hands out short term cell phones for clients who might not have one. And he’s set up an isolated office at Wentworth Douglass for people to access a computer to do telehealth.
He’s also worried whether people who are just now seeking treatment are able to do so at all.
“We’ve had a significant reduction of walk-ins, yet still multiple ones per day,” he said. “ But our call volume has gone up, we’ve switched to doing everything or as much as we can as much remotely.”
The pandemic has also exposed long standing shortcomings in how New Hampshire treats those with a substance use disorder.
In normal times, there are already wait lists or long drives to see a provider.
Nelson Hayden, who runs the Doorway at Cheshire Medical in Keene, says sometimes the window of opportunity to connect someone who’s decided to seek treatment with the appropriate care can be limited.
“People don’t just wake up in the morning and have their fresh juice and cinnamon roll and say, ‘Hey today’s a good day to address my substance use disorder, ’” he said.
There’s usually a catalyst behind that decision: a legal concern, health concerns or loved ones.
But now with COVID-19, “treatment is more difficult than in ideal times.”
Hayden says he’s worried about a drop in already-limited spaces for more intensive substance use disorder treatment.
For example, Hayden refers clients to the Brattleboro Retreat in Vermont for detox and medically monitored withdrawal.
But the center has stopped accepting out-of-state patients because of the pandemic.
“That’s a problem because residential treatment will have liked someone to have detoxed before they get into residential treatment, especially if they are at risk of health issues with their withdrawal,” he said. “We have this whole pipeline that has been severed.”
So, while people are waiting to get into residential treatment, Hayden and his team do daily check-ins or provide weekly counseling sessions until a person is connected with a provider.
Nelson is hoping that he can offer more services sooner. In February, he sent in an application to the state so that his team can provide medication assisted treatment (also known as MAT) at his facility. That involves using medication and counseling to treat addiction.
“If we can get somebody started and get them into a safer place, while we’re waiting to connect them,” he said. “I have no desire to be the leading MAT provider in Cheshire County, however, if I could help somebody, that would be a nice thing.”
Essentially it’s a stop gap. A person could get started on treatment right away with Nelson, but they would still need to wait to connect with a doctor for more consistent access.
But in some ways, the pandemic has made getting access to MAT is easier during the pandemic. The federal government has waived the requirement that people need to see a provider in person for their first appointment. Instead, that appointment can happen over the phone or through a video call.
Then, people can pick up their prescription at a pharmacy and attend group therapy sessions through Zoom calls.
Hayden does have a list 28 pages long of online support groups that he can recommend to clients.
And while for many it is helpful to connect through calls or video chats, both Hayden and Fifield, who directs the Doorway program in Dover, says they’re concerned how social isolation and distancing may affect those in recovery.
“With increased anxiety comes more craving and potential relapse to old patterns,” Fifield said.
“I worry about three months from now, when we’re on the back end of this curve, and the whole world is trying to pick up the pieces, what does recovery look like then, and what does seeking recovery look like?”
But the current limitations have forced providers to redefine what success looks like in treating people dealing with addiction right now. That’s how Fifield is seeing it.
“Yes, we might have a person that needs a higher level of care, but I need to adjust and do the best I can at this level because a higher level isn’t available,” he said.
That’s what Fifield calls a harm reduction model -- so maybe a person is using three days less than they did the previous week, and that is counted as a success.
“As opposed to no, you’re not 100 percent in recovery, you’re not abstinent. That kind of a thing,” he said. “Seeing a patient’s success in that way allows us to think differently and encourage differently -- they’re working on a success and not a continuation of failures.”
What he’s working with, he says, is not an ideal scenario, and highlights some of the weaknesses in New Hampshire’s addiction treatment system: like waitlists and limited number of beds.
But Fifield says he hopes some of the changes, like increased use of telehealth for treatment, will stick around after the pandemic.