A Tale of Two Epidemics: Coronavirus Exacerbates Substance Abuse Issues

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While COVID-19 has become the dominant catastrophe of the moment, other longstanding crises have taken a backseat in the public eye.

The opioid crisis, an epidemic that has taken many more lives over a much longer stretch of time, is seeing a new rash of overdoses since the start of the pandemic.

Data provided by Suffolk County Police shows overdoses have generally increased from the same months last year to this year. In March, police counted a total of 14 fatal overdoses compared to 27 in 2019. There were 108 nonfatal overdoses compared to 93 last year. In April, the numbers jumped wildly from 15 fatal overdoses in 2019 to 30 in 2020. Nonfatal leaped from 67 to 113.

District Attorney Tim Sini’s (D) projections of overdose numbers tell an even more morose tale. With data that includes ODs that weren’t confirmed yet by toxicology reports, seeing a total increase of 19 percent of both fatal and nonfatal overdoses compared to the previous year. Though those numbers include all overdoses, not just related to opioids.

While it may be too soon to determine a specific link between the pandemic and the increase of overdoses, drug counselors and rehabs say they have seen the marked connection between isolation, mental illness and drug dependence. As time goes on and the country faces economic turmoil, some worry the situation may not improve for the rest of the year.

Addiction Relief Shifts to Remote Help

Dr. Carol Carter, the director of the Sunshine Prevention Center in Port Jefferson Station, works especially with youth and parents dealing with mental health and drug-related issues. She said her center quickly had to scramble after the state first started closing down. Since then the center has been hosting most programs over Zoom or in Facebook Live sessions. They have especially tried to focus on appreciating diversity, the issues of isolation and other anxieties. They have done children’s book reading and puppet shows over the internet as well, looking for ways to maintain positivity. They have also connected with families by dropping off care packages and calling families each week.

But while such meetings may be a substitute for counseling sessions, Carter said the main difficulty is preventing people from getting on drugs, especially as so many remain cooped up indoors, many in unstable situations.

“We’ve seen an increase of response hotline, in depression and suicidal ideations,” Carter said. “We’re still collecting data, but we’ve heard of an increase in domestic abuse, an increase in substance use, alcohol abuse, as their way of coping with isolation.”

Director of Drug and Alcohol Counseling Services at the Smithtown Horizons Counseling and Education Center, Matthew Neebe, said it’s hard to gauge if there has been an increase in drug use since the pandemic as the center is not facilitating toxicology screenings. Yet, he added there is “anecdotal” evidence for the pandemic causing and increase in relapses and drug use.

“Two of the biggest risk factors for substance use are social isolation and stress,” he said. “Both are consequences of the stay-at-home orders.”

While the center itself is considered essential, they have continued to operate at a reduced level. However, with most staff working from home, all therapy sessions are done via telehealth. They have been conducting some group sessions virtually, though they have reduced the number of sessions from their regular schedule.

Anthony Rizzuto is the director of provider relations for Seafield, a drug rehab with inpatient facilities in Westhampton and outpatient facilities in Amityville, Medford, Mineola, Patchogue and Riverhead. He said they too have been hearing of the increase in overdoses and the increased use of alcohol and other drugs as more are quarantined at home.

“We know people will turn to drugs or alcohol, and God knows right now we have plenty of stressors — we have people who have lost loved ones, people who have lost their jobs, people who are in financial ruin, some are losing their businesses,” Rizzuto said. “We see an increase right now, and quite honestly I expect a huge increase as this continues going on and after this is over, if this ever happens.”

While there are obvious downsides to telehealth, the push is one that was in the docket for a while, and with the current pandemic, has finally pushed many institutions into taking it seriously, said Dr. Christian Racine, the senior director for clinics for the Family Service League Long Island. The nonprofit social services agency also runs the Diagnostic, Assessment and Stabilization Hub in partnership with Suffolk County.

The benefits, Racine said, include allowing people who may have had mobility issues or other mitigating problems the chance to get into the system. People who call the hotline for the clinic or DASH center are now immediately put into the system, where they can connect with people to understand what the person is going through and what services they should get connected to. It also allows for flexibility in time and location, no longer requiring a person to drive what can be a long distance to start the treatment process.

FSL’s Mobile Crisis Teams continue to operate, often going to a person’s home to talk through the door or even speak to a person through video chat or phone right on the person’s driveway.

“We didn’t see a drop in services, [but] an increase in services because of flexibility of being able to use telehealth,” Racine said. “People are being frank about increased cravings or relapses.”

Though there still are several downsides to telehealth. Perhaps the most egregious is for those living in unstable home conditions, where the person on one of the calls may not want others to listen in.

“Even if you get along with the rest of the family, you’re worried about what you’re sharing or you’re hesitant to share certain details,” he said. “Some don’t have the best relationship with their families. It’s absolutely a concern, and we’re very conscious of that.”

While Rizutto acknowledged some of the benefits of telehealth, he said he preferred the in-person meetings where he said “a lot is being said nonverbal.”

Otherwise, with so many resources shut down, from in-person AA meetings to churches to gyms, “Zoom really played a part to give people something,” Rizutto said. “People are in those meetings who had never been to therapy, before people from all over. It is definitely meeting a need.”

Government and Police Response

Suffolk County Police Chief Stuart Cameron said cops have noticed increased incidents of drug overdoses, though despite the emphasis on social distancing police are still able to administer Narcan, a life-saving drug that halts an opioid overdose.

But with treatment and prevention as the more important component of substance abuse, the pandemic presents its own unique challenges.

“It’s not just opioids — people are self medicating, people are isolated,” said Suffolk County Legislator Sarah Anker (D-Mount Sinai). Anker is the legislative chair of the Suffolk County Heroin and Opiate Epidemic Advisory Panel.

The trend is troubling, especially compared to Suffolk County’s previous models showing total overdoses are on the decline. In January, Suffolk released a report showing 2019’s projections of opioid-related deaths was 283, compared to 2018’s 380. Those decreased numbers of deaths were attributed, in part, to the greater use and availability of Narcan.

Anker said the numbers have caused real concerns among other members of the opioid advisory panel. In a meeting Friday, May 8, panel members discussed tapping into county forfeiture funding to create public service announcements on mental health and the different places to receive drug treatment. The panel also would look to advocate that the federal government should allow people to use Medicaid funds for teleconferencing, which it currently does not cover.

Sini said Suffolk County has not seen a decrease in drug-related activity despite the pandemic. This is mostly due to the nature of how drugs enter into Suffolk — smuggled into New York City then is sold wholesale to dealers on the ground, who usually drop it off to peoples’ houses or are picked up at select homes.

“We’re not seeing any drop except for powdered cocaine, but we’re not seeing that same situation with heroin or fentanyl,” the DA said.

Sini said while other crimes like break-ins have declined, the office has allocated more resources to the narcotics bureau, now standing at 13 narcotics prosecutors, which works closely with police to track dealers and prosecute them.

The DA’s office is also planning to roll out a new program that would work with a yet-to-be-named nonprofit and shuttle people in addiction to treatment providers. Sini said there will be more information on that program in the coming weeks.

The initial rise in COVID-19 cases forced the rehab facilities to cut back in bed capacity, especially as hospital-based detoxes turned into beds for COVID patients. Since then, as the number of hospitalizations declined, Rizzuto said now bed supply is better, but of more concern is funding for these facilities.

“Either a state-funded facility, nonprofits or private entities, I think the budget is going to be ravaged and with the lack of being able to collect, they will be looking to cut,” Rizzuto said. “I think they are going to have to cut in many different areas to meet the needs financially. Historically behavioral health is one of the things that gets slashed.”

Anker said members of the advisory panel have expressed their concerns for many different programs’ funding, especially as New York State reports huge drops in income. Many nonprofit rehabs and centers rely on such funding.

“Drug addiction is not decreasing, it’s increasing and they may be taking away those resources,” Anker said. “We may not hear it now, but we will see repercussions come out as we deal with pandemic.”

Maintaining the breadth of services, from inpatient care to outpatient care to paying for nursing and other medical staff, the rehabs and prevention centers requires a heavy dose of government funding. Racine said restructuring Medicaid could provide a necessary boost of aid.

“The idea of state funding being reduced is really a concern — a lot of services are expensive,” Racine said.

Despite the efforts of both government, for profit and nonprofit organizations, officials said they don’t expect numbers to return to the way they seemed to be heading only a year ago.

“I think it would be very hard to end 2020 on a decline,” Sini said. “We will see an increase in 2020, but we will all be working to bring those numbers down in 2021.”