Tanzina: As the coronavirus ravages communities across the United States, another epidemic continues to unfold in the background, the opioid crisis. Last year, preliminary data from the CDC showed that nearly 72,000 people died from an overdose. The majority of those were opioid-related. During the pandemic, the situation may be worsening. According to the Washington Post, suspected drug overdoses jumped 42% in May, compared with the same time last year. Though advocates and public health officials have been sounding the alarm on this epidemic within a pandemic since March, federal state and local officials have been slow to respond as they've had to prioritize the threat of COVID-19. For more on this we're joined by Dr. David Fiellin a professor of medicine and the director of Yale's program in addiction medicine. Dr. Fiellin, thanks for coming on The Takeaway.
Dr. David Fiellin: Thank you for having me.
Tanzina: Also joining us is Duaa Eldeib, a reporter for ProPublica Illinois, who's been covering the opioid crisis in Chicago. Duaa, thanks for joining us.
Duaa Eldeib: Thank you.
Tanzina: Dr. Fiellin, when we look at the opioid crisis nationally, has the pandemic made it worse?
Dr. Fiellin: Yes. Without a doubt, there is evidence that in various parts of the country the ravages of the opioid crisis are being exacerbated by the COVID pandemic. This really affects a variety of populations, those individuals who are not in treatment, who may be impacted not only by the anxiety and the isolation of social distancing but also changes in drug supply and changes in their usual routine, in addition, individuals who are in treatment and who have been doing well, many have had changes in their life, including loss of jobs, restriction on jobs, changes in responsibilities and quitting increased childcare.
One thing we've done in the field is try to make sure that these individuals have access to appropriate treatment, including many of the medications which are the most effective treatment for opioid use disorder.
Tanzina: Dr. Fiellin, I'm wondering whether the overdoses that we're seeing are related mostly to fentanyl or other drugs.
Dr. Fiellin: One thing that's important to highlight, and I think the COVID pandemic has really highlighted this issue is that we- really the lack a data infrastructure that allows us to access real-time information that is needed to fight an epidemic such as the opioid crisis. We have certainly a lot of data on the COVID pandemic and testing and mortality, and that information is needed similarly for the opioid crisis.
Issues around fentanyl and issues around overdose are paramount in the opioid crisis. Unfortunately, the overdoses that we're seeing are just the tip of the iceberg. They really reflect a high access to high-potency opioids such as fentanyl, but we need to understand that not only are this population being impacted by overdoses but their lives are being disrupted by their undoing drug use, and their families are suffering as well.
Tanzina: Duaa, you are reporting how this opioid crisis is playing out in Chicago. What are you seeing in Chicago in the surrounding regions?
Duaa: The numbers are bleak, confirmed or suspected opioid overdose deaths have doubled so far this year compared to last year in Cook County. We're already at an estimated 1300 deaths due to opioids this year, which is higher than all the opioid deaths last year. Unfortunately, half of the confirmed deaths have been among black residents, even though black residents make up less than a quarter of the county's population.
As doctor was saying, the concern is that this very real, very fatal public health crisis is being overshadowed by the pandemic, which is also disproportionately killing black and brown people. With the focus on COVID-19, people in Chicago and across the country are dying in the shadows.
Tanzina: Duaa, what's happening in Cook County specifically?
Duaa: We're seeing a huge spike in opioid-related deaths. Many of the victims are on Chicago's West Side, including Austin, East Garfield park, West Garfield park. These are neighborhoods that are a majority black and areas that have seen decades of disinvestment, job loss, violence, there's hopelessness and desperation. People from affluent suburbs flock to these areas on what's been dubbed the heroin highway to get opioids. What exacerbates the tragedy is that these are the same areas that have been hardest hit from the coronavirus. Families are losing their loved one to the pandemic and losing their loved ones to the opioid epidemic.
Tanzina: Duaa, what does treatment look like during a pandemic with the numbers that you're citing that are so high in this part of Chicago? Are people accessing treatment? Is it even available? Are we seeing fewer people showing up at the emergency room because they were afraid of getting COVID, for example?
Duaa: That's exactly it. Fewer people are going to ERs because they were told at the beginning, "Don't come because of COVID." Now, public health officials are saying, "Look, the hospitals are safer, come," but there's still this very real concern that they might contract COVID. They're trying to get the message out, "Call 911, get the overdose reversal drug, come into the hospitals, because if you come to the hospitals, it's more likely that you will survive."
Tanzina: Dr. Fiellin, what are you hearing from the patients that you talk to about how the pandemic has affected their treatment? What are some of the things that you're hearing through these folks?
Dr. Fiellin: Again, I think it varies quite a bit depending on where the patient is or individual is in their drug use. Certainly, there have been situations in which patients have taken on new responsibilities at home, including childcare. They're spending more time at home rather than at the job. These types of changes in their routines can be very problematic for any medical condition, but specifically for opioid use disorder. Oftentimes, patients get very comfortable with certain routines that help them to stay in remission and not relapse.
When those things get disrupted, in addition they start to feel anxiety about access to their medications. They miss the routine opportunities to check in with their treatment providers, with their counselors, and for some individuals who are accessing self-help groups, such as AA or MA, those have all gone online, and many people are not comfortable with that. It's certainly been challenging. I think they very much appreciate the opportunity to speak to their providers if they can't meet with them in person, but it's been a big challenge for many of our patients.
Tanzina: Dr. Fiellin, what are state and federal governments, are they doing enough to respond to the crisis right now?
Dr. Fiellin: There've been a number of federal initiatives put in place, including increasing the dispensing of medications, such as methadone. Now, individuals can get that for a 14-day supply or a 30-day supply, specifically buprenorphine, another medication that can be provided out of an office based setting that can now be initiated without an initial face-to-face visit. Those are specific programs that were put in place as a result of the COVID pandemic and the health emergency that we're seeing.
I think one of the things that's very important is that a number of states and local entities had programs in place that they were going to use to fight the opioid crisis that have been disrupted by the pandemic. There needs to be concerted effort, concerted resources to continue those programs, make sure that they get successfully implemented and help make continue the progress that we're seeing prior to the pandemic.
Tanzina: Duaa, what about specifically in Chicago and in Cook County? What's the status, for example, of Naloxone? What are the other resources that the city and state potentially are offering to this population?
Duaa: There simply is not enough Naloxone. The County has applied for and gotten some federal and state grant money to increase the supply, but it's nowhere near where it needs to be. The idea is to flood these communities where they're seeing these surges and opioid-related deaths, but they just don't have enough Naloxone to do it.
Tanzina: Dr. Fiellin, are you concerned about whether we will, frankly, see more people die because of opioid overdoses as a result of this pandemic right now?
Dr. Fiellin: That's a huge concern. I think, undoubtedly, that will be the legacy of these colliding epidemics. I refer to this as our preexisting condition. This was a challenge that we were facing prior to COVID, and we're just starting to make some progress. We still have a long way to go to address the opioid crisis and making sure that the public understands the nature of the disease, that they understand that there are appropriate treatments.
We need to address the stigma that's associated with opioid use disorder and its appropriate treatment. We need to improve our data infrastructure. We need to develop our workforce and, quite frankly, we were starting to initiate some important clinical trials and research studies that have all been put on hold, not to mention the settlements with the drug makers, the pharmaceutical companies and the distributors that have also been put on hold. There was a lot of progress that has been halted, and without concerted effort, we will undoubtedly see increased mortality, as well as morbidity.
I think, again, that the death and the fatal and nonfatal overdoses that we see are just a tip of the iceberg, that there are so many other lives and individuals and families that are impacted and ravaged by this disease, and we're just not getting ahead of it.
Tanzina: Very serious things that we will be absolutely following. Dr. David Fiellin is a professor of medicine and director of Yale's program in addiction medicine, and Duaa Eldeib is a reporter for ProPublica Illinois. Thanks to you both.
Dr. Fiellin: Thank you.
Duaa: Thanks for having us on.
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