In tandem with an increase in anxiety and depression, 13% of Americans reported starting or increasing substance use to cope with stress and emotions related to the COVID-19 pandemic. With the misuse of opioids and stimulants also on the rise, overdoses have spiked.
“The COVID-19 pandemic has fractured social structures – there’s a lot of isolation, loneliness, unemployment and desperation,” said Robert Levy, MD, a family medicine and addiction medicine specialist at the University of Minnesota Physicians (M Physicians) Broadway Family Medicine Clinic. “This is a ripe environment for drug use because they might make you feel better initially. The risk is that the more you take them, the more likely you are to develop a use disorder.”
Apart from providing the services of a typical clinic, the Broadway Family Medicine Clinic has additional expertise for patients experiencing a substance use disorder, including a care coordinator, project manager and ongoing research aimed at transferring best practices into patient care.
Treating Substance Use as a Chronic Illness
“I would estimate that about 10% of our patients have some sort of substance use disorder,” Dr. Levy said. “We treat substance use disorders like we treat all other chronic illnesses.”
Dr. Levy compares treating substance use disorders with treating diabetes. While there are lots of medications that can help with both chronic illnesses, lifestyle changes are also an important component of improving health.
“We’re trying to figure out how other interventions, like behavioral activation or contingency management, might help patients in an outpatient setting,” Dr. Levy said.
Studies at the Broadway Family Medicine Clinic are exploring contingency management, which uses incentives to help people reduce or discontinue substance use. This might include giving patients tokens for a raffle every time they have a negative toxicology screening, go to their appointment or attend an AA meeting.
They’re also looking at the role of parenting and pregnancy within substance use disorders along with how telehealth and race might impact outcomes. The Broadway Family Medicine Clinic’s unique approach has earned federal and state grant funding to support medication-assisted treatment and training of future family medicine physicians.
“As primary care partners, we want to help people be healthier and prevent overdose deaths, which are unfortunately skyrocketing lately,” Dr. Levy said.
Every U.S. state has reported an increase in overdose deaths during the pandemic, with the prevailing theme of fentanyl’s involvement. Since many individuals with use disorders struggle with multiple disorders, they might be inadvertently exposed to fentanyl in a variety of substances.
“It’s more complex, especially on the inpatient side, because of these unique acute withdrawal intoxication syndromes and the rise of synthetic drugs,” Dr. Levy said. “I’m trying to integrate addiction medicine into primary care by helping people set realistic goals for their health. It’s unrealistic to expect someone with a use disorder to be fully on board with the treatment plan and execute it to a T. People need incremental changes.”
While there’s a focus on addressing serious health risks, like providing naloxone (Narcan) to patients who use intravenous drugs, Dr. Levy said it’s also important to meet people where they’re at and develop a relationship. Traditional abstinence-based treatments do work for some people, but many patients don’t have the option to go to high quality inpatient treatment programs because it’s expensive and might require taking time away from work, school or family obligations.
“Use disorders are chronic illnesses, and like the vast majority of other chronic illnesses it can be treated in primary care,” Dr. Levy said.
With substance use on the rise, it’s also important to know the signs of overdose, which might include being very sleepy, having trouble breathing, being unresponsive or having a blue complexion.
“If the individual is experiencing any of these symptoms, and especially if you suspect they’ve used drugs, you can administer Narcan,” Dr. Levy said. “Narcan is very safe and has very few side effects, even if you administer it on someone who isn’t overdosing. The benefit of Narcan is huge.”
Narcan is now available over the counter at many pharmacies in Minnesota, including nasal and intravenous kits. Studies show that it’s extremely effective at reducing overdose mortality and saves lives. When Narcan is administered, it’s imperative to seek medical help even if the individual’s condition improves, since multiple doses are sometimes needed. For those experiencing a substance use disorder, there is help available, and approaching the situation with empathy is key.
“If people aren’t acting like themselves or are more isolated, depressed, miss things or seem to be out of money, approach them with compassion and curiosity,” Dr. Levy said. “At the Broadway Family Medicine Clinic we create a non-judgmental, caring, compassionate environment for patients. We offer a large array of help, including counseling, detoxification and outpatient treatment.”
Dr. Levy recommends that referring providers regularly screen for use disorders since they’re so common.
“This is much more common than people realize,” Dr. Levy said. “The lifetime prevalence of use disorders is about 12% and many people have mild to moderate use disorders.”
M Physicians has many providers at multiple sites with expertise in addiction, and for patients with mild to moderate use disorders, a primary care doctor is the best way to start on the road to recovery.
“You’re not alone. So many people are struggling with this, especially now,” Dr. Levy said. “There is more help available in an outpatient setting than there has ever been.”