Organizations providing addiction treatment and harm reduction services in Rio Arriba County could not afford to skip a beat as they adapted to new challenges amid the COVID-19 pandemic.
Without these essential services — hypodermic needle exchanges, medication-assisted treatment programs and naloxone distribution and education — people would likely die.
This meant organizations such as The Mountain Center and El Centro Family Health had to quickly restructure how they operate, so doctors, nurses, case managers, behavioral health therapists and others could continue to serve patients in a county with a drug overdose death rate that’s about four times the state and national averages.
The required changes extended far beyond ensuring patients follow social-distancing guidelines and refrain from gathering in large groups.
If people with substance use disorder go untreated, they will be at a high risk of contracting the novel coronavirus, which causes COVID-19, said Dr. Leslie Hayes, a family physician at El Centro Family Health.
“If you’re hustling every day to get heroin or methamphetamine, you can’t social distance,” Hayes said. “You will get into contact with people who are probably in contact with many other people.”
The federal Substance Abuse and Mental Health Services Administration has released guidelines for how to safely serve patients with substance use disorder during the pandemic.
Providers can prescribe buprenorphine, a drug used to treat opioid addiction, over the phone, Hayes said, and they can offer monthlong prescriptions rather than a one- or two-seek supply so patients don’t have to make repeated trips to the pharmacy.
One of the biggest changes across the board has been the switch to telemedicine.
There’s a lot providers can do in a 15-minute phone call, Hayes said, though El Centro is open for patients who need higher-level care, such as a pregnant woman on medication-assisted treatment.
“It is such a boon for us to be able to use telehealth,” Hayes said. “My encounter numbers are actually up.”
Many of her patients find the telephone visits easier than in-person appointments, she said.
Philip Fiuty, the harm reduction program manager at The Mountain Center, said it is continuing to operate its mobile services program. Every day, a van travels to different rural communities to deliver clean needles, distribute food, pass out naloxone and help connect people with other services they need.
“I think right away we began, you know, educating people about what was happening [with the pandemic], but also increasing the amount of supplies they were asking for, if they wanted an increase, so they wouldn’t have to travel and see us or us having to see them every day,” Fiuty said.
While distributing naloxone has been a regular part of The Mountain Center’s services, there has been a recent push in Rio Arriba County get more of the opiate overdose-reversing medication into the community.
“Our goals for the next maybe month or so is to keep our clients alive, and we are shifting to harm reduction,” said Lauren Reichelt, Rio Arriba County’s health and human services director. “We want to keep them alive until we can solve this problem.”
The county provides case management to more than 200 people, and a lot of their services have been disrupted, Reichelt said. While the county continues to help people get to their appointments for treatment, the focus is now on naloxone and making sure people are socially distancing.
The push to increase distributions of naloxone is critical right now, said Tony Dixon, the executive director of The Mountain Center.
“During this time, the risk factor can go up — with just the amount of anxiety, depression, joblessness, these kinds of things in our society that can contribute to other social-emotional pressures — for people to potentially use more,” Dixon said. “We need to have more naloxone out there for people to give that life support if someone were to overdose. If a loved one, a family member were to overdose, then they have a tool to be able to revive that person.”
In the first nine months of the fiscal year, Fiuty said, The Mountain Center has reported 543 successful overdose reversals through the use of naloxone.
The potential of a patient’s relapse, and developing a plan to address it if it happens, is something therapists and clients also have to talk about, said Tracey Garcia, the behavioral health director at El Centro Family Health.
“Right now, it’s awesome because we can pick up the phone and have those important lessons, especially relapse prevention, how to cope with triggers, how to be creative right now in the time COVID,” Garcia said.
The phone works well for many patients, she added, but some do not have cellphones or have a limited number of minutes.
Garcia said she initially was concerned about making a switch from in-person group therapy sessions to using Zoom, an online videoconferencing service. But the new format has worked well.
“It’s almost like patients are even more willing to share now,” Garcia said.
Clients are sharing resources they’ve found that are helping them while they remain at home during the pandemic, such as online Alcoholics Anonymous and Narcotics Anonymous meetings.
“They’re … helping each other, and I think that helps them feel good,” Garcia said.
But the potential for a patient to feel stress, have a relapse, miss an appointment or get sick is still there.
People have to remember this is temporary, Garcia said.
“The only thing I can think of is the message of hope,” she said. “We are really making it a point to give that to every patient that we are meeting, whether it is over the phone or face to face: This now. This will change. This isn’t the new normal.”