The structure designed to support and help rebuild broken lives was suddenly unsteady.
The coronavirus pandemic has gripped the overwhelming attention of the medical community and public for the past 11 months. But while everyone has focused on the virus, an ongoing crisis in Johnson County and Indiana has only worsened. The opioid epidemic swelled in 2020, as people struggling with addiction have been stuck inside, cut off from support systems and dealing with constantly changing routines.
At Tara Treatment Center, people struggling with substance use disorder came to recover. Those in the residential program received a combination of therapy, education, and 12-step support to change their thinking and behavioral patterns. Other people enrolled in intensive outpatient services to develop and maintain strategies to prevent relapse.
Everything the facility offered was designed to give clients a steady routine and hold them accountable for their actions, proven to be key components to sobriety. Then the COVID-19 pandemic injected virtual meetings and uncertainty into the process.
“The main thing that works for people getting into recovery is the structure and accountability piece. It’s difficult to have that accountability piece when you’re just seeing them over a computer screen,” said Jennifer Parker, clinical supervisor at Tara Treatment Center.
“There were already challenges before the pandemic, just dealing with addiction and everything that comes with that. Now you add in COVID, and it’s multiplied.”
Data paints picture of how bad it got
Data shows that overdoses jumped significantly, and deaths from opioids were higher in March through June of 2020 compared to the same months the previous year.
Not only has COVID-19 threatened to wipe away progress made throughout the state against opioids, but its impact will likely reverberate for years in the future.
“Pre-pandemic, we were really making a lot of progress. We had seen our overdose death rates had fallen at twice that of the national average. We had seen our opioid prescribing rates decreasing,” said Doug Huntsinger, executive director for drug prevention, treatment and enforcement for the state. “If you look at the course we were on, things were going really well. Then the pandemic hit.”
Comprehensive data on opioid deaths and addiction during the pandemic months is still being tabulated and finalized. But the indicators that are available show how difficult last year was for those with substance use disorder.
The Overdose Detection Mapping Application Program provides near real-time suspected overdose data across the United States. First-responders and agencies, such as the Indianapolis Metropolitan Police Department and Marion County Public Health Department, connect to the program to upload suspected overdose data.
According to the data, 62% of counties participating in the program experienced an increase in overdoses after March 19, when the first lockdown due to the pandemic took effect in California.
Suspected overdoses increased 17.6% from March 19 to May 19, compared to Jan. 1 to March 18.
Other data show the rise in overdose cases in Johnson County and Indiana during the pandemic. Starting in March, Indiana emergency medical services reported 1,206 uses of naloxone, a drug used to reverse opioid overdoses. That number jumped to 1,313 uses in April, 1,745 uses in May and 1,742 uses in June.
Johnson County had 27 reports of naloxone use in March, 34 in April, 52 in May and 31 in June. At the same time, 18 county residents died from opioid overdoses, compared to 5 during those months in 2019.
Emergency room visits due to overdoses across Indiana jumped nearly 50% last year, Huntsinger said.
“Twenty-eight days into this new year, we’ve already seen more opioid overdoses in emergency departments than this time in 2019 or 2020,” he said. “We’re not getting better.”
Recovery center: What worked doesn’t now
The exact cause of the jump in overdoes is hard to pin down. But substance use disorder experts stress that structure and support from others is key to recovery, and that was largely disrupted during the pandemic.
“We have such a forced social isolation. People do not have those connections that may have been their healthy strategies for dealing with stress in the past,” said Stephanie Anderson, CEO of Recovery Center of America in Indianapolis. “They may feel more lonely, and that’s really scary.”
Recovery Centers of America, which opened its Indianapolis in-patient recovery center in December, implemented COVID-19 testing when patients are admitted, then weekly and as required throughout their stays. All outpatient services, such as group therapy and education, individual counseling and targeted skill-building, were moved to a telehealth format.
Outside visitation has not been allowed, so officials created a series of webinars for families and a weekly family support group. Family visits and therapy sessions have been held virtually.
From their clients, the pandemic added challenges to helping people understand they might have an addiction problem, Anderson said.
“It’s very easy as we’re working from home and staying socially isolated to fall into further negative coping skills related to substance abuse and slide completely under the radar.
At the same time, it has increased hesitancy in people wishing to get help themselves.
“People are working from home, so the expectation is that you are available and working. So this idea that you’re going to take some time away and focus on yourself, to get the treatment that you need, you’re expected to be available. Why in the world would you need to take time and go somewhere?” Anderson said. “The pressure to work is even greater, and that’s a huge barrier.”
When the pandemic hit, Tara Treatment Center acted quickly to transition its approach which encouraged connection and preventing someone from being separate from the group setting, Parker said. Clients were encouraged to sit together, and cannot wear baseball hats or use blankets to close themselves off.
With a focus on social distancing, that approach flipped.
“It’s been a very big adjustment in trying to maintain and gain that personal interaction and personal connection from a therapeutic standpoint,” Parker said. “With having to maintain distance, with having to wear a mask, that loss of the personal interaction piece has been huge, whether that’s for people on the residential end or outpatient.”
Initially, outpatient clients who were signed up for recovery meetings had to gather via Zoom as opposed to being together in a room to support each other. Twelve-step meetings hosted by the facility have gone online, and recovery programs such as yoga and art therapy were held virtually as well.
Support for family members of those with substance use disorders have been put on hold. Families have been unable to visit loved ones who are in Tara’s residential program.
“It’s hard for our clients not to be able to see their families while they’re here,” Parker said. “We do those visits over Zoom, so you lose that personal touch.”
The nature of the pandemic has also resulted in delays in getting people the services they need, Parker said.
“If they’ve been exposed to the virus or (they’re) having symptoms, they can’t get services in a timely manner because they have to be symptom free or have a negative test to access our residential program, or even attend outpatient groups,” she said.
State tries to curb inevitable impact
Just as recovery treatment facilities have had to adjust as best as possible to care for their clients, state health officials have allocated funding and resources in an attempt to counteract the damage.
Gov. Eric Holcomb and the Indiana Family and Social Services Administration in May announced the state would fund a nearly $1 million distribution of naloxone, working with the advocacy group Overdose Lifeline to distribute 25,000 doses to first responders, families, friends and others who are likely to be the first on the scene if someone overdoses.
A crisis hotline called Be Well was created in July, which allowed people to call 2-1-1 and talk to a trained counselor free of charge. Since it started, more than 6,000 calls have been fielded.
Plans to implement regional recovery hubs — organizations grouped together in regions of the state to provide easier access to addiction services — were accelerated in 2020.
“The numbers are going in the wrong direction. But we’re able to quantify it and put these programs in place,” Huntsinger said.
Officials will not know the true impact of the pandemic on the overall opioid epidemic and substance abuse in general for years. But it seems likely that it will certainly have a lasting, negative effect for many, Parker said.
“For some people, it will, whether it’s because they experienced a relapse because they weren’t able to attend meetings in person, or just not having access to support or resources that they needed,” she said.
