After COVID-19 addiction treatment may never be the same

The COVID-19 pandemic has brought a lot of things to America, including death, panic, and a whole lot of change. We’ve all seen the changes in our day-to-day lives as we adjust to working from home or being unemployed, social distancing and isolating. But what’s tough to see are all the other changes going on in the world because we are so isolated. And so much is happening out there that’s newsworthy that it can’t all possibly receive media coverage since everything is so corona-centric these days. This includes a significant revolution in the field of substance abuse treatment, which isn’t getting much attention and probably should.

Addiction treatment has been in a longstanding gridlock between the old and new schools. Old school treatment was a very tough-love approach, welcoming all but being tough on people. It placed personal accountability as a central theme and drove home the “once an addict, always an addict” mentality by encouraging people to accept that they were powerless. If the person isn’t in control, they best avoid all substances altogether forever.

Even though this generation fostered in the approach that addiction is a disease and a medical issue, they still relate addictive behavior to moral shortcomings like dishonesty, selfishness, and manipulation. The “group” meeting and treatment approach began here, becoming the prevailing model to this day.

The new school of addiction treatment is very medication oriented. They associate addiction with mental health, considering it a behavioral disorder, which is no fault of the person. Of course, it’s treated with drugs, usually psychiatric or narcotic, and is known as Medication Assisted Treatment, or MAT. Many from this school view relapse as part of the process, rather than a failure. They push for stigma-free attitudes and changes in the vocabulary surrounding addiction. Rather than having a negative connotation, activists of this approach want to see addiction normalized and viewed in a more positive light. Harm reduction is a tool used heavily, as it’s more important to save a life than push treatment.

These two schools have been in a stalemate over the last decade as technology has improved. The new school has been heavily advocating opioid replacement medication like Suboxone and Methadone; harm-reduction approaches that have slowly become mainstream “treatment” philosophies. The new school would have every opioid addict on these drugs, often for the rest of their lives. Because they’re opioids, the person would still be technically “dependent” on these medications, a state which the new school would consider rehabilitated. The old school would vehemently disagree, finding the person just to be replacing one addiction with another. Arguments ensue, no one wins.

Well, COVID-19 is changing all that. Where previously MAT drugs were tightly controlled, the pandemic has forced regulatory agencies to loosen up. Patients used to have to go to specialized clinics to receive these medications, sometimes daily.

They are so few, and far between that, sometimes thousands of people would go to the same place to wait in line each day to do this. This is contrary to social distancing guidelines, so exceptions have been made. Patients can now take home up to 28-days’ worth of Methadone and may be prescribed Suboxone via virtual appointment.

The new school and proponents of MAT have been pushing this exact kind of change and ease of access for years. It isn’t as though we didn’t have the technology. But there are obvious reasons why these things weren’t allowed in the first place. For starters, you can’t drug test someone who isn’t in your office. It would be impossible to tell via telehealth if the patient was just continuing to do heroin and selling their medications for profit to fuel their drug habit. Also, MAT drugs are controlled because they have abuse and overdose potential.

Giving someone with a history of addiction a month’s supply of a drug like that could easily spell disaster.

But the concerns over COVID-19 outweighed those of drug diversion and overdose, at least in the minds of those who approved these new guidelines.

Now that these restrictions have been relaxed and the genie is out of the bottle, there are many who think it cannot be put back in. Getting facilities to go backward and put all these measures back in place after COVID-19 will not go over well with anyone, especially patients. And that’s assuming that the pandemic goes away sometime soon. But those who have been pushing for this day will get a chance to see whether broadly applied harm reduction measures work or end up causing more harm.

Joseph Kertis is an experienced health care professional turned journalist. His experience in the field of substance abuse and addiction recovery provides a unique insight into one of our nation’s most challenging epidemics. He utilizes this knowledge in his writing to give an expert viewpoint that spreads awareness through education. He is a featured author of the health care website Addicted.org. He lives in the Newport region of Lincoln County, Ore.