Economic shutdowns and uncertainty fuel opioid epidemic in N.C.

In the shadow of the coronavirus pandemic, New Vision Therapy is still fighting the opioid epidemic. Overdoses are increasing, patients are relapsing, and providers are trying to prevent the death toll from rising in Greensboro. But two patients are already dead. 

“It’s terrible. These folks were working really hard, but the pandemic, with all of these stressors — kids at home, loss of jobs, health care, getting COVID,” Mat Sandifer, director of Clinical Services, told Carolina Journal. “They’re tired of wearing masks, not being able to find employment, they’re losing homes, trying to feed their families.”

North Carolina is losing any progress it made in the fight against the opioid epidemic. Across the state, doctors are watching their patients relapse, overdose, and die.

Gov. Roy Cooper’s shutdowns have been particularly cruel to Americans suffering addiction. Isolation, stress, and unemployment all drive substance abuse. As weeks dragged into months, the coronavirus pandemic and the shutdowns have fueled a wave of overdoses.  

North Carolina succeeded in driving down opioid overdose deaths in 2018, lowering the death rate for the first time in five years. The pandemic and the shutdowns shattered that victory. 

North Carolina won’t know the full cost of the lockdowns until the pandemic abates. Damaging the economy fuels deaths of despair, but that data will be slow to materialize, especially since North Carolina still relies on a “dead tree” death reporting system. 

But North Carolina’s emergency rooms saw 678 opioid overdoses in September — a 20% increase from 565 visits during September 2019. Overdose deaths rose an average of 13% across the nation this year over last, according to the New York Times. 

“Some of the progress we made with opioid addictions, we lost,” said Victor Armstrong, director of the N.C. Division of Mental Health at N.C. Department of Health and Human Services.

Not all of the overdoses are unintentional. The shutdowns have created a storm of mental health problems. Almost 40% of adults reported struggling with mental health or substance abuse in June. One in 10 adults reported seriously considering suicide, according to the Centers for Disease Control and Prevention.

“People are coming in with overdoses that are actually suicide attempts. That’s been the biggest uptick,” Rhonda Cox, Chief Population Health Officer at Vaya Health, told CJ. 

In Charlotte, veterans are slipping back into substance abuse, says Dr. Nicole R. French, clinical director of Veterans Bridge Home. Her team reviews patients’ bank statements, and what they’re finding worries them. 

“You can see, oh, wow, three trips to ABC this week,” French said. “When unemployment increases, mental health concerns increase.”

Calls to the National Alliance on Mental Illness helpline have soared 70% above their levels last year. Before the pandemic, the helpline only saw one or two actively suicidal callers in a year. Now they get a suicidal caller every month, says Virginia Rodillas, who manages NAMI’s helpline. 

“It’s pretty much impacting everything and every caller,” Rodillas told CJ. “I’m hearing from people whose loved ones have always tried to manage a mental health issue. And now they’re basically pouring alcohol over it.”

But the state also risks crippling its ability to fight the opioid epidemic in the future. 

The coronavirus shutdowns hit addiction treatment providers hard across the state. As revenue plummeted, 43% of providers said they couldn’t survive another month. More than half have closed at least one program, and a fourth of clinics have laid off staff, an April survey by the Addiction Professionals of N.C. says.

“I’m scared to know. I’ve been in this field for 25 years … and I’ve never seen it this bad,” said Sarah Potter, executive director of Addiction Professionals of N.C. “Behavioral health is always underfunded. There’s never enough money to meet the need, but I’ve never seen a situation this bad.”

New Vision Therapy lost almost half of its revenue before stabilizing at a 30% financial loss. Its federal relief is exhausted. But its clinicians are defying financial trends and expanding telehealth services. 

“It’s a bold move. Trust me, I think about it at night,” Sandifer said. “The rural counties already have few providers. And the providers they have are usually getting by month-to-month. Patients are scrambling — where am I going to go? Back to the street?”

But drugs on the street have become more lethal with fentanyl’s spread. And getting patients off the street has also become more complicated. 

The pandemic decimated the capacity of in-patient treatment centers. 

Many can’t use their group rooms. Widespread testing allowed UNC Health to set up COVID-19 positive psychiatry units, but not all providers have the ability, said Dr. Samantha Meltzer-Brody, director of the UNC Center for Women’s Mood Disorders.

“There’s an inadequate number of beds for addiction nationally,” Meltzer-Brody said. “Everyone is trying to innovate quickly, but you can’t do a whole renovation project in two weeks.”

The General Assembly put millions toward fighting the crisis in mental health and substance abuse. Providers say they’re grateful. But patients are still losing jobs and health insurance, and not all clinics will survive. 

“I have been sick to my stomach since this started,” Potter said. “It’s not because of being worried about getting COVID. It’s knowing that people who we could help aren’t getting help, and we’re losing them.”