Coronavirus ‘will drive up overdoses’ as SC grapples with pandemic amid opioid crisis
Hassan Salaam read quietly from an addiction recovery book inside his small bedroom during a gloomy afternoon in Greenville on Monday. The written testimonies from other men and women fighting addictions help him persevere.
But before long, he was interrupted by a text message. Then another one. The texts are more common now.
"A lot of people aren't coming out at all, so this is the only way to connect," the 51-year-old New Jersey native said after replying to a friend's text. "People are quarantining themselves, so this helps."
The reality of the coronavirus pandemic has made those in recovery a vulnerable group disproportionately at risk of exposure to the virus and susceptible to their own relapse, according to treatment providers and experts in South Carolina.
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Isolation is highly discouraged if recovering from drug addiction, according to treatment providers.
A typical recovery plan requires regular check-ins with counselors, peer support group meetings and often physical visits to clinics to receive doses of methadone, one of several drugs used to ween someone off an addiction.
“(Coronavirus) will drive up overdoses. It will drive up people going to the street,” said Rich Jones, director of FAVOR Greenville, a nonprofit that offers drug addiction treatment services. “This is where holes in the system get exposed.”
Salaam, 51, has been three years sober after battling a heroin addiction most of his life. He's been living at Freedom Recovery Center in Greenville for close to a year, after previously living in Charleston where he relapsed.
A three-quarter empty bottle of Equate hand sanitzer sat near a collection of recovery coins by his bedroom door. The bottle's not usually there — in fact, it's been stashed away for years, but Salaam recently began using it again, he said.
What keeps him going is group meetings, lots of groups meetings — places where fellow men and women in recovery check in with each other, hug, laugh and build a sense of community.
"A hug will go a long way in someone's life. We can't do that," Salaam said. "Isolation can take you away from recovery."
Some meetings are still held where there are places to meet outdoors or in larger gymnasiums where those in recovery can spread out and keep proper social distancing, but others have stopped meeting.
The Phoenix Center, a rehabilitation center in Greenville County, began offering digital recovery groups early last week and began limiting its larger treatment groups while restricting visitor access, said Curtis Reece, a center spokesperson. Additionally, only nine beds there are now available for detoxification as an effort to ensure there is only one patient per room.
Traditional groups for many nonprofits have turned to technology to host online meetings, but it's still not quite the same, Salaam said. He said he has noticed some men he typically would see at a meeting are no longer showing up.
He worries about relapse and overdose in an age of social distancing and isolation amid the ongoing coronavirus pandemic.
"I don't let coronavirus control my thoughts," Salaam said. "All you can do is pray through this and pray they don't relapse."
At opioid treatment programs, where medications are given out to aid people coming off an addiction, steps are being taken to limit person-to-person contact and keep those exhibiting symptoms of illness from coming into the office – but sites are staying open for now.
“We are a necessary healthcare facility,” said Dr. Haley Neal of Carolina Treatment Centers, which has offices in Anderson and Duncan, and an office in Asheville, North Carolina. “We have no intention of closing, unless something massive comes down the pipeline.”
South Carolina – particularly in Greenville County – has already been ravaged by the opioid epidemic, according to most recent overdose death data from the state Department of Health and Environmental Control.
The Palmetto State saw 1,103 overall overdose deaths in 2018, including 172 in Greenville County alone. The county had 131 opioid-related overdose deaths in 2018, compared to 73 in 2017.
By Monday, DHEC had announced nearly 300 people in South Carolina had tested positive for COVID-19 with five confirmed deaths related to the virus. Greenville was in the top five counties with 31 of the state's positive cases.
Also on Monday, Gov. Henry McMaster ordered law enforcement to enforce the prohibition of public gatherings of three or more people, exercising a law that can be made available during states of emergency.
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The federal Substance Abuse and Mental Health Services Administration gave orders last week to allow opioid treatment programs to approve take-home doses of addiction treatment medications like methadone and suboxone.
The order allows some patients who are deemed at lower risk of relapse to get up to 28 doses of medication to take home to limit their public exposure, rather than showing up to a clinic for daily dosing.
“We judge on a patient-by-patient basis how stable the patient is and you balance the risk – you balance the risk of them being out in public versus the risk of having more medicationthan they might normally take home. These are not decisions we make lightly,” said Dr. Trey Causey, the chief medical officer for Crossroads Treatment Centers based in Greenville.
For those patients getting extra doses, physicians are doing more remote check-ins and phone calls, he said, to help bridge the gap in this interim.
“You don’t want to just turn patients away,” he said.
New patients, however, who are exhibiting any signs of illness are not being seen, he said. If someone is healthy and looking to get on a medication-assisted treatment plan, then they were still able to see physicians face-to-face.
Marc Burrows with Carolina Health and Wellness of Powdersville said his biggest fear is for people needing medications but are unable to access them if governments are advising residents to stay indoors during the coronavirus outbreak.
“We might see an increase in overdose deaths. If people don’t have access to medication or treatment, it’s not going to be good,” Burrows said.
Burrows also worries fewer people will come to offices that hand out naloxone, an opioid overdose reversal drug that’s been more prevalent in recent years and seen as the front-line antidote to combat overdose deaths.
He said if his office shuts down, staffers are committed to delivering doses of naloxone directly to patients and communities.
At Freedom Recovery Center, a transitional living community off Wade Hampton Boulevard, COVID-19 fliers are stacked at the front door next to a bottle of disinfectant spray. Most group meetings have switched to online, though some residents there have brought out some lawn chairs on nicer days to meet at a distance.
Michael Todd, the director ofFreedom Recovery Center, said he worries about those new to recovery and not already plugged into groups or transitional homes.
"That’s very challenging and concerning to us folks carrying the message," Todd said.
FAVOR Greenville’s administrative office has been closed since early last week, but virtual counseling sessions online continue, Jones said.
“It’s a bigger problem than just regulating treatment groups because these people are going to go through withdrawal if they don’t have a contingency plan,” Jones said. “It’s deeply, deeply troubling.”
Because of the changes, FAVOR is implementing a 24-hour hotline for those in need across South Carolina to call in to speak with a live recovery coach any hour of the day, Jones said.
The federal government last week urged citizens to not gather in groups of more than 10, an effort to reduce the rate of transmission. That’s counter to typical addiction support group meetings. FAVOR runs daily classes of roughly 60 people at noon, and evening classes of about 30 people in the evenings. Those have been canceled.
“Really what we’re doing now is a bunch of outreach, a bunch of phone calls,” Jones said. “We’re not allowed to respond face-to-face but are still doing phone intervention.”
For now, providers are leaning on telemedicine efforts and virtual check-ins with patients to sustain their recovery process.
“Frequent contact of any sort goes a long way,” Causey said.
Daniel J. Gross is an investigative watchdog reporter focusing on public safety and law enforcement for The Greenville News. Reach him at firstname.lastname@example.org or on Twitter @danieljgross.