By David Travis Bland
COLUMBIA, S.C. (AP)—As the mounting death toll from the coronavirus grabs headlines, a quieter killer has fed off the isolation induced by the virus.
Drug overdoses have sharply risen in South Carolina, according to South Carolina agencies that track deaths.
The upturn in overdoses follows the ascension of COVID-19 cases since March, when the virus was first detected in the state. The trend has led addiction specialists to believe the virus has not only forced people in drug recovery to distance themselves from treatment but also has lured them closer to their substance use. The virus has also knocked people out of the rhythms of life that help keep addiction under control as drug treatment tries to adapt to changes, treatment professionals say.
Melanie Peebles, a managing clinician at LRADAC, a drug use treatment operation in Richland County, witnessed the deadly effects of the relationship between substance use and the coronavirus.
A man she helped treat for substance use lost his jobs as the coronavirus halted the economy in March. He was sober for two years. But when his work went away, heroin crept back into his mind, and he relapsed. In April, he used the drug for the first time since getting sober; it killed him, Peebles said, unable to hold back tears.
His tragedy is a growing reality during the time of COVID-19 in South Carolina.
Opioid overdoses have increased nearly 50% compared to this time last year.
Before the virus hit, if Peebles went two weeks without hearing from a patient, she was scared.
“We're even more afraid now for their safety,” she said.
‘NEVER AN EASY JOURNEY'
Opioid overdoses in South Carolina were already higher when 2020 began than the previous year, according to the Department of Health and Environment Control. When the coronavirus hit in March, things got even worse.
Between January and May, the last month DHEC has compiled data, the number of survived and fatal overdoses rose 47% from the same time period in 2019.
In May alone, South Carolina set a record for overdoses, with 915, compared to 540 in May 2019.
The trend has hit Richland and Lexington counties. Both rank among the top 10 counties in the state for opioid overdoses this year, according to DHEC.
In Lexington, the number of lethal overdoses in March, April, May and July leapt over the same months in 2019, statistics from the county's coroner's office show. In April, eight people died from overdoses, compared to two last year. May proved deadlier, with 11 people dying, compared to two in 2019.
“We know that social isolation for people who struggle with substance use oftentimes increases their use,” said Jeremy Martin, vice president of treatment and intervention at LRADAC.
Having a job and supportive friends and groups within reach help people stay sober, he said.
“When those things are taken away from a person, oftentimes their use is likely to increase,” Martin said.
The coronavirus stole these pillars of sobriety from people trying to recover from substance use, many of whom already deal with homelessness, abusive relationships and other obstacles that increase their risk of using drugs to cope.
While stay-at-home orders in March and April as well as social distancing brought on by the virus kept many people safe, for people trying to recover from drug use, these new rules were a double-edged sword.
People often fatally overdose when alone because others aren't around to call paramedics or administer an overdose-reversing drug like Narcan, Martin said.
As people dealing with drug abuse have had to spend more time away from others, Martin saw the sad and foreseeable consequence for overdose deaths.
The ones who could face the greatest harm from the dual threat of isolation and substance use are those who have just started toward recovery, treatment specialists said, particularly with heroin and opioids.
People who regularly use heroin and morphine—both powerful opiates—and fentanyl—a stronger, synthetic opioid—build up a tolerance to the drugs and have to use increasing amounts to feel the same effects. When first starting recovery, a person's tolerance for these drugs goes away quicker than many realize, Martin said. When a relapse occurs, a person often uses the same amount as before sobriety, not knowing their body can't handle such a dose.
The coronavirus took away the personal connection to support groups and clinicians for those in who want to start recovery and those in the early stages of sobriety. Being able to see and feel the presence of others who care and know the struggle of use and recovery is tantamount for those taking the first steps, Martin said.
“It's never an easy journey, and I'd never tell anyone it is,” said Martin, who recovered from drug use decades ago. “When you can find early recovery, it just opens so many doors to a new life.”
The number of people getting treatment for substance use is down 40-50% at LRADAC and statewide since the virus hit, Martin estimated.
Even as the coronavirus tries to shut the way, Martin and the people at LRADAC are keeping that door open as wide as they can.
When The State caught up with Peebles, she was looking an audit and going through clinicians' paperwork at her home. She's in front of a computer a lot of days now.
Online video calling patients is one of the ways LRADAC has adapted its processes to ensure people in recovery continue to get some sort of human connection and care.
LRADAC has changed outpatient treatment, medication services and withdraw management, also called detoxing, to work around the limitations created by COVID-19.
Like many other institutions, LRADAC was stunned and stunted in March when the virus first hit. Getting going again through April meant a general reduction in drug use treatments.
People who used to come in for six to nine hours a week for outpatient treatment now receive a one-hour visit from a clinician online—and that's if a patient has an internet connection. So LRADAC got a grant to purchase phones for patients, which has helped, Martin said.
By the end of June, LRADAC was able to start back the nine-hour weekly sessions with virus precautions for the people at highest risk of starting to use again.
Its treatment facility had 18 beds in nine rooms for monitoring people detoxing. It had to cut the beds in half to make the rooms single occupancy. The same decrease has happened across South Carolina at state-funded facilities, which were reduced from 60 beds to 30 in total. And screening for the coronavirus delays the start of people's detox.
The adaptation are not ideal, Peebles and Martin said, but they want people to know that LRADAC is there to help.
“We're going to do everything that we can to make it work,” Martin said. “We're not able to meet as high a standards as we used to meet, but we're at least able to support the patients we have and accept new patients.”
Beyond a contraction of treatment, people with substance use are missing markers for progress because of the virus, Peebles said. Affirmation from family and friends, meeting milestones established by courts and movement toward getting custody of children have changed or are no longer in sight for some because of the virus' effects.
“We have to help our folks understand that, yes, you are making progress,” Peebles said.
Peebles believed another patient had lost all progress in April. He'd come to treatment at LRADAC for three years. About mid-April, he disappeared. None of the clinicians heard from him for weeks. It was one of those moments that dug a pit of fear for Peebles.
In June, after weeks of calling him, his LRADAC therapist was able to get him on the phone. He'd lost his job and was going through family issues. He'd relapsed but wanted to start treatment again. Not giving up on a patient, “That really made a difference,” Peebles said.
“That said ‘I really care about you.”'