What happens when an ongoing epidemic collides with a pandemic? Some who want to get well falter

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Jennifer Anderson talks about battling her addiction through the new coronavirus pandemic. Underground AA meetings to Zoom meetings. Cincinnati Enquirer

Isolation is the enemy.

Jennifer Anderson watched helplessly as her boyfriend spent two days early in April isolating himself in their bedroom in Covington watching endless TV news about how COVID-19 was threatening the globe.

"People who are drug addicts, you're seeing it on the screen, it's gonna get to you," she said. Her boyfriend took off to the streets after that, besieged by that familiar compulsion to use drugs to cope, and although he eventually sought treatment, she lost track of him for days.

Which made her own recovery more precarious.

Anderson tried to hang on by offering help to others. On April 7 she posted to Facebook:

"Today is a beautiful day. I'm so grateful I woke up. Sober and not dope sick. I have healthy relationships in my life. Sober people that love me just the way I am. We all deserve that. We are NEVER alone. I'm here if you need to talk or just need someone to listen. Call me. ... Anytime."

She included her phone number.

It didn't dawn on her then that she needed as much help as her peers did.

Five days after that post, she was struggling to hold onto her sobriety.

"I'm tired," she said by phone.

What was once hard about staying free from addiction is now harder.

An epidemic that was difficult for most people to appreciate is now an epidemic that's in hiding. It's the epidemic of overdose deaths that killed almost 1,296 people a week in 2018. Seventy percent of those deaths involved an opioid.

It's an epidemic thatcontinues to kill people every day.

The novel coronavirus has taken the stage. But those still in need of help for addiction now must jump new hurdles.

These are hurdles that make getting counseling harder, make getting human contact harder and make getting food, clothing and shelter harder.

For the diligent, telehealth counseling has replaced face-to-face therapy sessions. Discreet sober meetings and intimate faith services have been swapped out for Zoom and Facebook Live encounters.

For those in active addiction who depend on libraries for internet access and an ability to join digital counseling sessions, the closure of public libraries has shut the door on even that lifeline.

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Andersonis 40. She has wrestled with addiction for years with a fierce determination to stay well, but this COVID-19 threat and all that it has brought with it has hurled a new level of anxiety her way.

"It's been hard," she said.

"I was used to three groups a week, three hours a day, so that filled up my time," Anderson said. "Then it was gone."

The structure of those in-person meetings with peers, maybe getting a peer sponsor and eventually, helping others, often helps those in recovery maintain their sobriety.

"You become a link in the peer chain of recovery," said Dr. Mina "Mike" Kalfas, an addiction specialist with St. Elizabeth Physicians Journey Recovery Center in Northern Kentucky.

Addiction is a chronic, often relapsing health condition that, when treated with medication, counseling and other support can be effectively managed.

Experts felt like they were making progress now that medication-assisted treatment has become more commonplace.

Now, as the pandemic continues, treatment providers are trying to prevent setbacks – to, in effect, bend the links among those in recovery into a new shape, so that people with addiction can get help without risking their lives to COVID-19. And without succumbing to a recurrence of addiction.

To their credit, experts were not taken by surprise.

"We saw this coming," said Dr. Roberto Soria, chief medical officer at Crossroads Clinic in Corryville, and addiction specialists planned for it.

As stay-at-home orders bubbled up across the United States, the federal Substance Abuse and Mental Health Administration announced guidelines in March that allowed states to take the lead in how methadone providers would give medication to patients. Instead of coming to a clinic every day, people deemed stable can take home up to 28 days of medication, depending on state rules. Ohio's rule restricts take-homes to 14 days.

Still, some are left out: "The only people that we cannot give it to are the people who are actively using fentanyl," Soria said.

His clinic has put in place safeguards to protect clients. Temperatures are taken outside. Inside, floors are marked at 6-foot intervals for those waiting in line for methadone. The number of clients allowed in at one time is limited to 12. The clinic has extended hours so that fewer people will be there at any given time, Soria said.

Pew Research Center also put out strategies for care of those with opioid use disorder during the pandemic. Among recommendations: Have a lead point of contact who ensures patients are following a comprehensive care program.

Elsewhere, doctors who prescribe buprenorphine products such as Suboxone, which diminishes opioid cravings, are reevaluating patients to learn who can have prescriptions for a longer duration.

Anderson said her prescription, originally a week's worth of Suboxone, was extended to two weeks through the University of Cincinnati College of Medicine's Addiction Sciences clinic, also in Corryville.

That helped, she said, because she didn't have to find a way across the river every week. Her counseling was restricted to phone conversations. That proved harder.

Locating peer support she felt she could trust was not easy, but she managed to do it for a while.

"There’s a lot of underground AA meetings that people are doing in their yards and at farms, and you have to reach out," she said on April 6. "They’ll help you."

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In the Cincinnati area, treatment providers want people to know there is help.

The Center for Addiction Treatment in the West End is trying to get word out that services are available. First Step Home in Walnut Hills, which provides housing and treatment for pregnant women, is reaching out for clients.

The Northern Kentucky Office of Drug Control Policy continues to link those with addiction to treatment. "We have had an increase of inquiries around reentry or recovery resources, where folks are asking for sober living or food services as well as online recovery resources," said Director Amanda Peters. Outreach looks different: Less face-to-face contact, more door hangers outlining treatment options.

Dr. Shawn Ryan, founding partner of BrightView Health, which has nearly 5,000 medication-assisted treatment patients in Ohio, said patients have adjusted rapidly to the call-in appointments.

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Not everything is going smoothly.

In Greater Cincinnati, Quick Response Teams, which go to the homes of overdose survivors to link them with treatment, have suspended operations. "The biggest part of QRT is that rapport ... when you knock on the door. We've lost that relationship," said Tom Fallon, investigative commander of the Hamilton County Heroin Task Force.

Hamilton County Public Health temporarily changed its syringe exchange operation, an effort to prevent the spread of HIV and other blood-borne infections, to appointment-only. The plan tentative plan is to reopen the week of May 18 with outdoor services.

The exchange has drawn some clients. In a three-week span, from March 30-April 20, 231 appointments were made, and 139, or 60%, were kept, records show. Participants received Narcan and a month's worth of syringes to help keep public contact down.

But for some, the restrictions were too much to manage in their already chaotic lives.

One woman who routinely used syringe exchanges before the COVID-19 outbreak stopped going. "I haven't even tried," she said early in May.

So far in Hamilton County, overdose counts have remained stable when compared to 2019. But on April 23, the county's addiction response team issued an alert, saying 13 people died from suspected overdose in just five days, and 911 calls about overdose were up.

Other Ohio coroners have reported spikes in overdose deaths. The Franklin County coroner saw six deaths in 24 hours early in April. And in mid-April, the coroner's office reported via Twitter that five people died from overdose in 12 hours.

Compounding the issue, doctors who treat addiction are beginning to see the erosion of previous progress in some patients.

"We're seeing pretty good attendance to our physicians' video visits," said Kalfas, "but some of the patients seem to be skirting the therapist."

Peer support specialists and case managers are calling patients more in response, and doctors are increasing drug screens for some patients to counter setbacks, he said.

The results of the screens aren't always good.

"I'm starting to see substances creeping in," Kalfas said. "I'm starting to see meth and even some of the older stuff: A little more heroin. A little more cocaine."

Newtown Police Chief Tom Synan, a coordinator with the Hamilton County Addiction Response Coalition, suspects the fentanyl supply, largely from China, has decreased with the coronavirus pandemic. He believes other drugs – heroin, cocaine – are being used in its place, exacerbating the addiction crisis.

No one knows yet how much the new crisis will affect the one that's been here for years.

"It'll be tough to tell exactly what impact the crisis has had on patients with opioid use disorder until we see at least a few months of trends," Ryan said.

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Inside those trends will be the individuals who make them, including Anderson.

For her, the day-in-day-out pressures that piled on with COVID-19 were too much to manage.

"You can't see your psychiatrist. You cant see your counselor," she said.

In mid-April, she felt so alone and anxious that she broke her no-drug-use rule and started taking Xanax, a benzodiazepine sedative sometimes prescribed for anxiety, but known to cause dependence. It triggered her active addiction, again.

"You do it because you want the pain to stop," she said.

It was a medication she'd long ago been prescribed, along with the opioid painkiller Percocet, after a fall in her mother's home. That's what started her addiction disorder 20 years ago.

Some uncertain number of days after she relapsed, Anderson went to Sun Behavioral Health in Northern Kentucky to detox. She doesn't remember much of the stay.

By April 20, she decided she'd have to get farther from the Cincinnati area to recover. The drug scene is too ingrained here, she said.

She arranged for a Karen's Place treatment advocate to pick her up in a Covington park on April 22 and drive her to the center, in Louisa, Kentucky.

"I am a nervous wreck," Anderson told The Enquirer by text on her way.

She texted once more: "I'm doing intake now. It's a really nice place."

It has been a hard road, with the pandemic capsizing so much of what she'd learned about staying sober. But Anderson has remained unwavering in her persistence.

"I'm OK," she said early on. "I’m gonna be OK."

"No matter what, this is just part of my story.”