Epidemic collision: Coronavirus disrupts addiction treatment


Breanna Dixon does not recall struggling to breathe as a result of an overdose, whereas her younger brother Joshua has not forgotten the sound.
Initially, it sounded like heavy snoring emanating from the TV room of the Dixon family’s Fontana residence, where the siblings were taking shelter with their parents.
A month had passed since the novel coronavirus paralyzed California, and Dixon, 28, was struggling. In the two years that she had used opioids, she had overdosed twice previously. She found herself using more than ever when she was at home with her family and soon-to-be-ex-boyfriend.
While others were stockpiling water and toilet paper, Dixon stocked up on oxycodone pills tainted with fentanyl, a dangerous and potent opioid.
She said that the stress of not knowing what will happen in the world, in addition to having to deal with the mundane tasks at home, was overwhelming. I felt like I couldn’t fix it and that I’d already caused so much harm to my family, so I needed to find ways to cope with a number of issues.
That April night, 23-year-old Joshua Dixon could tell something was amiss with his sister, who went from jittery to sleepy. When he heard what he believed to be loud snoring at 4:00 a.m., he checked on her.
He discovered her sitting upright with her head resting on her chest.
I took a closer look and realized that she wasn’t snoring, so I shook her on the shoulder and yelled, “Wake up!” Joshua Dixon said. She was not awakening.
Breanna’s ex-boyfriend called an ambulance and remained on the phone with the 911 operator until paramedics arrived with naloxone, a drug that can reverse an overdose.
A little over an hour later, Joshua Dixon discovered his sister’s ex-boyfriend collapsed in the backyard. He had also overdosed.


As people turn to illicit drugs to cope with the pandemic’s stressors, mental health experts fear they will encounter this crisis more frequently. According to scientific journal warnings, this confluence of epidemics could amplify the dangers of both.
The number of Californians killed by the coronavirus is tallied daily on public dashboards, but its impact on illicit methamphetamine and opioid use is more difficult to monitor. It is unclear whether more state residents are relapsing or overdosing.
Nonetheless, several local health departments in California and emergency rooms participating in a statewide treatment effort have observed a decline in the number of drug addicts receiving treatment since the pandemic’s arrival in the state. Comparing April to January, the Public Health Institutes CA Bridge Program reported 35% fewer people with opioid addictions in emergency rooms, nearly 48% fewer people receiving medication to treat withdrawal, and 24% fewer people attending follow-up appointments.
As the pandemic continues, experts worry that more people will fall through the cracks. And without an increase in state funding, budget cuts may hinder their ability to assist.
During this time period, fewer people are seeking treatment services, but relapses among those in treatment have increased, according to Jeffrey Nagel, director of Orange County’s Behavioral Health Services, which monitors trends among treatment providers.
During previous economic downturns, more Americans died from opioid overdoses, but fewer sought treatment for heroin addiction.
Gary Tsai, interim director of Los Angeles County’s division of Substance Abuse Prevention and Control, stated that there is likely a lot more substance abuse that is not currently being recorded in hospitals, emergency rooms, or jails. Once our communities reopen, there is significant concern that pending cases will emerge. I believe that to be a very real risk.
In California, the impact of opioids has increased over the past two decades. According to the state’s preliminary tally, more than 4,386 people died from drug overdoses in the first nine months of 2019, with approximately half of those deaths involving opioids.
It is too early to tell if the number of Californians who overdose has increased since the outbreak began.
Fresno has experienced an increase in suspected overdose deaths, although exact numbers are unavailable, according to Rais Vohra, the interim health officer for the county. Many other coroners’ offices have stated that there are too many bodies awaiting toxicological testing for any pattern to be identified. I believe this is only the tip of a much larger iceberg, Vohra stated.


Multiple drug abuse fronts are threatened by the convergence of epidemics. If smoking and vaping drugs have damaged their lungs or if opioids have stifled their breathing, their susceptibility to respiratory infections increases.
Nora Volkow, director of the National Institute on Drug Abuse, wrote in a recent paper that the virus’ social-distance measures also tear the fabric of medical care and social support for people who use drugs.
Feeling irrelevant and uncared for is likely one of the most debilitating emotions a person can experience, Volkow said in a recorded videoconference. It can dramatically increase the risk of drug use, and if you are trying to quit, it can increase the risk of relapse.
Prior to Breanna Dixon’s overdose in Fontana, Crystal Acosta in Oakland expressed interest in quitting drugs, and William Smith, age 60, was relapsing in Los Angeles.
Acosta, 33, who began using heroin at age 11 and lived in a tent with her partner during the height of the epidemic. She fears what she will do if drugs become scarce, struggles to remain safe on the streets, and frets over their grandson, who resides with his father.
When you use heroin, you get sick, and it’s even worse when you don’t have it. I’ve considered getting sober to avoid having to deal with that.
Acosta stated that she had been treated with methadone, which can reduce cravings and withdrawal symptoms. But because bus travel to a clinic was costly, she stopped going.
In Los Angeles, approximately 370 miles to the south, the pandemic sparked a chain reaction that led former Celebrity Rehab cast member Smith to relapse.
Smith claimed he had been in the entertainment industry for years and worked for a drug cartel, but he tried heroin for the first time while incarcerated in Chino. When the coronavirus began to spread in California, he had been recovering intermittently for about 20 years.
His employment as a caregiver was coming to an end, and with it, his housing.
Uncertain of his future, he relied on Narcotics Anonymous meetings to remain sober. He stated that being bored and by myself was the worst possible state for him. Then you get up and go to a meeting, where you begin to hear people’s woes and problems. It consists of comradery and friendship.
However, the pandemic necessitated online meetings, and he ran out of cell phone data for Skype. His prescription for a drug that suppresses opioid cravings and mitigates the high was filled. For the next few days, you’ll be fine, he said.
Then, he was no longer. He resumed using heroin and crystal methamphetamine. I felt awful, and I knew that was not how I wished to be, Smith said. And I knew how to return home.


Dr. Reb Close, an emergency medicine physician at Community Hospital of the Monterey Peninsula, is attempting to determine the number of individuals, such as Dixon, Smith, and Acosta, whose drug use has changed as a result of the pandemic.
Approximately every three days, her department’s record system alerts her to an overdose. (It is not the total, but rather an initial snapshot.) In May, however, the number of overdose alerts increased to one per day, she said.
You have the experimenters, Close said, recalling a teenage boy who likely overdosed on an opioid. His mother began CPR until police officers arrived with naloxone, which can reverse an overdose. The boy later told Close hed tried the drug because he was bored sheltering at home.
By Closes’s count, three of the twenty-two people who overdosed in March attributed their drug use to the virus. In April, seven of sixteen were present. She has not yet crunched the numbers for May.
You have your substance abuse recovery’s fragility, Close said. And in regards to the pandemic, she stated, “You have fear, hopelessness, and desperation.”
Smith was aware of where to go if he relapsed. His friend assisted him in finding a bed at one of the Tarzana Treatment Centers.
He stated that he did not anticipate that Tarzana or any of these large treatment facilities would still be operational. Many people would have perished if Tarzana hadn’t existed.
From 2019 to 2020, the number of people seeking treatment at Tarzana increased, and centers rushed to add beds to meet demand.
Since the beginning of this year, however, the monthly number of people seeking care has decreased.
Jim Sorg, the director of care integration at Tarzana Treatment Centers, stated that it is difficult to distinguish the effects of the pandemic from seasonal trends, as the number of people seeking treatment typically peaks in January and February.
However, patient apprehension of the virus may account for the decline. Obviously, Smith was a little nervous around other people, and I had no idea how they would keep us safe. I had to witness it firsthand.
Mask requirements, constant cleaning, multiple temperature checks per day, no outside meetings or visitors, and as much social isolation as possible were what he observed.
Smith stated that the changes have not hindered his recovery and may have even been beneficial.
He stated that the fight against COVID is similar to the fight against addiction, so one hand clasps the other. It is looking out for your neighbor, so your thoughts are always on something positive.
This year, officials in some counties with historically high overdose death rates report declines in the number of individuals seeking or being admitted to treatment. Sacramento, Santa Clara, Orange, San Diego, Riverside, and Alameda counties are included. San Bernardino also experienced an initial decline, but the number began to rise in May.
It is possible that federal regulations have changed during the pandemic to allow people to take home more methadone at once, resulting in fewer visits to clinics. One woman told CalMatters that it simplified the process of obtaining her medication.
Some individuals may also be unable to access outpatient services due to closures or a decline in referrals from courts and schools, among others. Some residential programs restrict admissions to maximize social distancing, and those without access to a phone or the internet may have been excluded from telehealth services.
Phebe Bell, director of behavioral health for Nevada County, stated that lockdown generally equates to a lack of access to vital services. People continued to be afraid of in-person services, despite their need for substance abuse assistance.
In some regions, more individuals are seeking addiction medication treatment. Los Angeles, Nevada County, and a major hospital in Santa Clara County have also reported an increase in demand, while San Francisco’s street medicine team has written two to three times more prescriptions than usual. During a pandemic, Bell suspects that medication, which requires minimal interpersonal contact, may seem like the safest option.


The picture of how the coronavirus will affect drug-addicted Californians is still evolving, but the past can help shed light on it.
According to a study led by Temple University economist Catherine Maclean, treatment admissions for stimulants increased by nearly 8 percent for every one percentage point increase in state unemployment during economic downturns. However, heroin use decreased by 6 percent.
In previous studies, economic downturns were associated with an increase in opioid-related deaths and emergency department visits.
Maclean stated that the results suggest an increase in unmet treatment needs, particularly for opioid addictions, during economic downturns.
Aimee Moulin, an emergency medicine physician at the University of California Davis Medical Center, is concerned about the gap between treatment need and availability.
The CA Bridge Program, whose principal investigator is Moulin, aims to close this gap. Opioid-dependent patients in more than 50 hospitals receive buprenorphine, a medication that alleviates withdrawal symptoms and cravings, and are connected to ongoing care. In the previous year, the program provided buprenorphine to 9,666 patients and provided treatment to 6,207.
Now we see individuals who were unable to obtain a treatment appointment returning. There are many delays and it is difficult to obtain medications, said Moulin. If it was a struggle before, closing down or reducing a significant amount of those resources makes it much more difficult.
Breanna Dixon is among the individuals who would have benefited from the CA Bridge Program.
The night she overdosed, she was transported to the hospital by ambulance. However, eight hours later she returned home, sweating and sobbing on her mother’s sofa. She stated, “I was withdrawing, and I could feel it, so I decided to use again.”
After being released from the emergency room, there is a period of danger. A recent study found that in the year following an opioid overdose, the risk of dying from another overdose is 100 times greater. Additionally, their likelihood of suicide increases 18-fold.
She looked for treatment programs accepting MediCal. It took her days to locate a detoxification hospital. Her mother, Jeannette Dixon, instructed her to continue looking throughout the entire ordeal, as stated.
She is currently residing in transitional housing after completing residential treatment.
I miss her terribly, but I understand that this is best for her. Jeanette Dixon, who has been in recovery for crystal meth addiction since 2012, stated that she needs it. Because who gets a third chance, you understand? She is lucky.


As the pandemic continues, government funding for treatment services is at risk of being cut.
Last year’s budget included $20 million for hospital counselors in behavioral health. The May budget revision by California Governor Gavin Newsom, however, eliminated it. It has been proposed by the legislature, but negotiations are ongoing.
In April, county behavioral health directors and seventeen other organizations petitioned the state legislature for an emergency hearing and funding. Thus far, neither has occurred.
Michelle Cabrera, executive director of the County Behavioral Health Directors Association, forecasts a shortfall of one billion dollars for county behavioral health programs by next summer, at the same time that the number of individuals who rely on them is expected to increase.
The legislature has proposed a $1 billion contribution to counties, of which $600 million is contingent on receiving federal funds. Cabrera estimated that behavioral health programs would only receive 230 million dollars.
It will not be enough to forestall some of the more difficult decisions we will have to make, said Cabrera. Were abandoning the human race.


In the interim, Crystal Acosta is already falling through the cracks in Oakland. In April, she cited the pandemic as a justification for getting clean. Two months later, she reported that she was consuming twice as much heroin as she had previously. Living without a home exacerbates the problem.
Were also humans. Acosta stated in April that they were not merely addicts. None of us have access to aid or dwellings. And wed be doing a lot better if we did.
Alameda County is attempting to combat homelessness and addiction by placing counselors in hotels set up during the pandemic.
Acosta, however, has not benefited. She stayed in a hotel for weeks, but is now back on the streets. According to Acosta, her partner was offered housing, but she declined because there was no room for her. Now, they sleep at friends’ houses or walk the entire night while smoking heroin.
It helps me relax to the point where I can handle everything, she said.
As a result of her disappointment at being homeless once more, she is less motivated to seek treatment. She asked, “What’s the point if they’re unwilling to assist me?”
The California Health Care Foundation and the Blue Shield of California Foundation support our health care reporting.


Experts worry that people will turn to illicit drugs to cope with the pandemic, but early signs suggest drops in Californians connected to treatment.