Opioids and COVID: Caught between two epidemics

Mark Sriedfertg was helping a friend move last week, when he noticed she had disappeared. He found her in the bathroom, blue-lipped and unconscious on the floor. 

“I didn’t have Narcan,” said Sriedfertg, who, at 58, has been in recovery from opioid addiction for nine months. “I applied ice to her groin and the top of her neck and waited for the ambulance.”

He was shaken but his friend survived. She told him later she didn’t have the money to pay for medication that had kept her sober after being laid off last month. A dealer gave her heroin on credit.

As the COVID-19 crisis continues, Tennessee’s other epidemic is seeing a deadly resurgence.

In Nashville, overdose deaths have nearly doubled since March 1 over last year, with 107 suspected overdose deaths between March 1 and May 20, according to the Metro health department. Last year, there were 57 overdose deaths during the same time period.

In Memphis, 58 people died of suspected drug overdoses from April 7 to May 7 — the highest county total in one 30-day period since health officials began collecting data. The death toll surpasses county COVID-19 fatalities.

In east Tennessee, Grundy County Sheriff Clint Shrum took to Facebook Live on May 6 after six people under the age of 40 overdosed in a 10-day period. Three died. 

Watch the video here.

“Let me just get real with you for just a second,” Shrum said. “I’m the sheriff in a county of about 13,400 people, and when you have young people drop like flies, it is very very concerning. And that becomes the number one issue in your office and in this county.”

The federal CARES Act provided $100 billion in relief funds to hospitals and other healthcare providers on the front lines of the COVID-19 epidemic. 

Opioid treatment programs, which treat opioid addiction with medication such as methadone and buprenorphine along with mandated counseling, have been excluded from the federal funding, which is tied to how much in Medicare payments were received last year.

Opioid treatment providers weren’t approved to receive Medicare payments until January 1 of this year, making them ineligible for funding to underwrite the cost of treatment.

For the majority of patients, the cost of treatment is paid out of pocket. 

“During normal times these are people who have jobs and do OK,” said Jay Higham, CEO of Behavioral Health Group, which provides medication-assisted treatment to 5,000 patients in Tennessee. 

“During COVID these are people who are losing their jobs,” he said.

Higham said the cost of treatment is about $115 per week, which includes medication, counseling, doctors visits and lab work.  About 4,500 BHG patients in Tennessee pay out of pocket, he said.  

“We’re trying to work with people and trying to help them stay in treatment,” Higham said. The growing number of out-of-work patients is happening at the same time treatment facilities are incurring higher costs for personal protective equipment and added staff retention costs, he said.

Behavioral Health Group is among scores of opioid treatment companies that are seeking $300 million in any future rounds of COVID-19 relief funding to pay for uninsured patients and increased operational costs. Thus far, the future of that funding remains uncertain.

Mia Carlson, an addiction counselor at Behavioral Health Group in Nashville, said job loss, isolation and lack of childcare are the biggest stressors for her patients during the COVID-19 crisis. Some of Carlson’s clients live at home with active drug users, increasing the risk of relapse. 

Federal and state regulations relaxed requirements for in-patient visits to lessen the risk of exposure in clinics. Most of Carlson’s counseling is now done over the phone.

“Sometimes our office was the only safe place,” she said. 

Sriedfertg considers himself lucky for now. He lost his part-time job at Ruby Tuesday’s when the restaurant closed to diners in March. Because he is disabled, his medication therapies are covered by TennCare. His wife works for Lowe’s and Kroger and her income has kept the family afloat, he said. 

“If I go back to using, I’ll be right back to where I started from,” he said. “Then I’ll probably be dead.”