President’s Update, Jul. ’20: Responding to the Intertwined Crises of COVID-19, Opioid Use, and Racial InequalityJuly 30, 2020
Since the pandemic began, FORE’s board members and staff have strived to be as responsive and flexible as possible in supporting our grantees as they continue to provide lifesaving treatment for people with opioid use disorder (OUD). We know these services are needed now more than ever. Newly released data from the CDC shows deaths from drug overdoses reached a record high of 70,980 last year, and overdoses have surged even more in 2020 as traditional office-based treatment for OUD has been disrupted and people are coping with job losses, anxiety, and social isolation.
Our most recent grants announced last week, fund organizations that are working to ensure poor, minority, rural, and justice-involved populations have safe, uninterrupted access to recovery services during the pandemic. One grant will help free clinics develop the capacity to offer OUD treatment via telehealth platforms, while another will offer counseling and other supports via a mobile app to people in drug courts and diversion programs. Other grants will train people with lived experience with OUD to become peer recovery coaches, helping engage people experiencing addiction and support them through treatment and recovery.
During this period of flux, it’s critically important that we investigate how emergency temporary policy changes made in response to the pandemic, such as relaxed telehealth regulations and waivers of some prior authorization requirements for medications for opioid use disorder (MOUD), are affecting access to care and outcomes. We hope our grants to researchers studying on-the-ground efforts will help identify ways to improve treatment delivery and policy over the long term.
At the same time, we want to serve as a convener, bringing together leaders in the field and those on the frontlines to share solutions and strategies for achieving them. Our most recent webinar, on July 16, was attended by some 400 people. We heard how racial disparities play out in access to OUD treatment and what we can do about it. Helena Hansen, M.D., Ph.D., associate professor of anthropology and psychiatry at New York University, led a discussion of what she described as the “perceived whiteness of the opioid crisis” that renders Black men invisible even though, as a group, they account for the fastest-rising rates of drug overdoses. They are also more likely than whites to be incarcerated than treated. To address the structural issues that perpetuate racism in our nation’s responses to the opioid crisis, Hansen called for investment in harm reduction and enhanced social services.
The webinar featured two such programs. One was the IDEA Exchange, created by Hansel Tookes, M.D., M.P.H., assistant professor at the University of Miami Miller School of Medicine. The IDEA Exchange operates Florida’s only syringe exchange program and offers naloxone packs for drug overdose reversals, HIV and Hepatitis C testing, wound care treatment and supplies, and linkages to drug treatment services, including MOUD. In recent months, the program pivoted to telehealth services. When patients lacked ready access to the internet, staff went to them with an iPad or hotspot to help them take part in virtual visits and also delivered buprenorphine to their homes. Tookes said COVID-era policies that waived requirements for face-to-face visits, urine drug screens, and other requirements have created a “new opportunity to offer lifesaving medications.”
Another effort led by Morgan Medlock, M.D., M.Div., M.P.H., chief medical officer and director of emergency services at the District of Columbia Department of Behavioral Health, has been engaging residents of wards seven and eight, which have the capital city’s highest rates of opioid overdoses. Medlock and her colleagues interviewed people with lived experience with OUD as well as families, neighbors, and community leaders to elicit their views on the OUD crisis and potential solutions. One key lesson is that people were often interested in systemic solutions to what they saw as a root cause of opioid use: economic disinvestment in their community — a challenge to academic medicine, which often has its own priorities, Medlock said.
Moving forward, FORE will continue to listen to the field, learn from the data, and find ways to make timely, targeted responses to the most pressing needs.