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Could the pandemic change addiction medicine for the better?

For many Americans facing addiction, the pandemic has made life significantly harder. Across the country, overdoses have soared, with more than 40 states reporting increases in opioid-related mortality. But the coronavirus is also changing how addiction medicine can be provided, and some experts are saying that could be a silver lining in a devastating public health crisis. Stephanie Sy reports.

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  • Judy Woodruff:

    For many Americans battling addiction, the pandemic has made life increasingly difficult.

    Across the country, overdoses have soared, with more than 40 states reporting increases in opioid-related mortality this year. But COVID is also changing how addiction treatment can be provided. And some experts are saying that it could be a silver lining in a devastating public health crisis.

    Stephanie Sy has our report.

  • Man:

    To be honest, I thought I was going to be sick the rest of my life.

  • Stephanie Sy:

    The pandemic has Dr. Stephen Loyd touting the virtues of going virtual.

  • Stephen Loyd:

    Are you cravings under control? I mean, are you doing OK? Do you run into times where it's overwhelming?

  • Stephanie Sy:

    Consulting patients through videoconference has opened up a new world for the addiction specialist.

  • Stephen Loyd:

    Oh, I know you are. I love seeing you. You know that.

  • Stephanie Sy:

    He used to have to evaluate patients in-person before he could prescribe two of the most common medication used to manage opioid addiction, buprenorphine and Suboxone.

    But, in late March, the Drug Enforcement Administration said it would temporarily relax those rules.

  • Stephen Loyd:

    Hey, do I send your medicine directly to your house?

  • Woman:

    Yes.

  • Stephen Loyd:

    OK. All right.

  • Stephanie Sy:

    Practitioners like Dr. Loyd now have the flexibility to prescribe medications via telehealth or over the phone, even to new patients.

  • John Wilkderson:

    I was extremely grateful that that was available.

  • Stephanie Sy:

    Last month, Loyd prescribed 40-year-old John Wilkerson Suboxone over the phone while he was in an emergency room suffering from severe withdrawal.

    He has been in recovery from an opioid addiction that began after a 2012 surgery. Without Suboxone, Wilkerson says he would take any opioid he could get his hands. The medication helps block his cravings.

  • John Wilkderson:

    I have been a much, much better husband and father. I feel like my old self again.

  • Stephen Loyd:

    It's been the biggest game-changer that I have had in my time in addiction medicine.

  • Stephanie Sy:

    Loyd is the former head of Tennessee's Department of Substance Abuse Services and now serves as the chief medical officer of 20 treatment facilities in Tennessee, Kentucky and Florida.

    He spoke to me via Skype from outside Nashville recently.

    Do you think that the opioid crisis, which was already an pandemic before the epidemic, is going to actually get worse because more people will turn to drugs?

  • Stephen Loyd:

    It's already gotten worse.

    And using telehealth, I get to see my patients in their home environment. And I have watched them from March go from nice apartments and houses they were living in to now hotel rooms, to now the back seats of cars.

    And I see it every single day. Our overdose rate here where I am is up about 20 percent with fatal and non-fatal overdoses.

  • Stephanie Sy:

    Loyd says telehealth has expanded access to safe treatment at a critical time, when experts predict opioid-related deaths could double this year because of the pandemic.

  • Stephen Loyd:

    If you think about the barriers that people have to getting treatment on an outpatient basis for something like opioid use disorder, number one, transportation, number two, fear of coming into an environment where you could be exposed to the COVID virus.

    Number three, the ability to get your medication, right? And so what telehealth has done is, it has allowed us to meet people where they are.

  • Stephanie Sy:

    While the National Institutes of Health say there's abundant evidence that medications reduce opioid use, an estimated 80 percent of Americans who could benefit from the drugs don't receive them.

    Case in point, 40 percent of U.S. counties don't have a licensed provider for buprenorphine, the efficacy of which Dr. Loyd himself is a living testament. Loyd describes his own downward spiral into addiction.

  • Stephen Loyd:

    There's a saying in recovery circles that one is too many and 1,000 is not enough. And that pretty much sums it up.

  • Stephanie Sy:

    Early in his career, he was driving home, feeling stressed, and found leftover hydrocodone pills prescribed to him by his dentist. He broke one in half and swallowed it.

  • Stephen Loyd:

    By the time I got home, suddenly, my life was better. Suddenly, this pain that I was dragging around with me and the anxiety and all the things I was worried about just kind of melted away.

  • Stephanie Sy:

    Within a few weeks, he was hooked. And the next four years, he says, became a constant pill chase.

  • Stephen Loyd:

    You know, every day became about, do I have enough to get through this day? Am I going to run out? Where am I going to get it next? But I couldn't quit, because, every time I didn't have the pill, I got sick, and it's all I thought about.

  • Stephanie Sy:

    Loyd even pocketed extra pills from his own patients.

  • Stephen Loyd:

    My use just accelerated so much. And then it becomes hard to find 100 Vicodin a day, right, even for me.

  • Stephanie Sy:

    By 2004, Loyd says he was no longer able to conceal his addiction from his family, and his dad confronted him.

  • Stephen Loyd:

    He said, "Steve" — he said, "You have a drug problem."

    I said: "Yes, daddy, I do." I said: "I don't know what I'm going to do." I said: "I'm going to lose my wife. I'm going to lose my house. I'm going to lose my medical license. I'm going to lose everything I worked my whole life for."

    And he said — he said: "Steve, none of that stuff's going to do you any good if you're dead."

  • Stephanie Sy:

    At that point, Loyd said he finally had the will to beat his addiction. But it wasn't enough. He also needed nine injections of buprenorphine at the beginning of detox.

  • Stephen Loyd:

    Medication holds cravings at bay. And it gives people a fighting chance, because people relapse because of cravings.

  • Stephanie Sy:

    It sounds like telehealth has really lowered the barriers for a lot of folks to get treatment, specifically medication assistance for opioid addiction.

    Why were those barriers so high to begin with?

  • Stephen Loyd:

    A lot of folks look at medication as a crutch: Oh, you're switching one drug for another.

    And it perplexes me, because we don't have problems treating other things that are largely behavioral with medication. And the example I always use is type 2 diabetes. Type 2 diabetes is largely behavioral, don't eat right, don't exercise enough, yet we treat it with medication all the time.

  • Stephanie Sy:

    But, unlike other chronic diseases, addiction carries strong stigma and shame.

  • Nicole Hernandez:

    That was embarrassing to me. I felt — I don't know. I just felt disgusting.

  • Stephanie Sy:

    Thirty-four-year-old Nicole Hernandez (ph) is one of Dr. Loyd's patients. She's in recovery from a prescription opioid addiction that began in 2008 after a near fatal car accident.

    She initially used powerful opioids to manage pain from her multiple injuries.

    At the worst point of this, how many pills did you need to take to dull the pain and to feel like you were addressing that issue?

  • Nicole Hernandez:

    Well, it depends on which pill. But, like, let's say, of the strongest ones, I don't know, like 20.

  • Stephanie Sy:

    Like many others who suffer addiction, Hernandez recalls becoming someone she couldn't recognize. She forged prescriptions and ended up in jail, only then realizing the hold the drugs had on her.

  • Stephen Loyd:

    Towards the end of your pregnancy, like, you didn't get craving more in the third trimester.

  • Nicole Hernandez:

    No. No.

  • Stephen Loyd:

    OK.

  • Stephanie Sy:

    Hernandez is now prescribed Suboxone, which helps lessen her continuous pain, she says, without the feeling of addiction and withdrawal.

    The virtual appointments have kept her from having to visit the clinic, no small comfort for the new mother of twins.

  • Nicole Hernandez:

    It's just been awesome, because I have never had to leave my baby's side.

  • Stephanie Sy:

    Loyd says, since telehealth became an option, patients' rate of showing up for follow-up appointments, a key to long-term recovery, has doubled.

    But, on its own, telehealth is not a silver bullet.

  • Stephen Loyd:

    Oh, there are drawbacks to it, and I think for the person that tends to isolate, because the opposite of addiction is not recovery. The opposite of addiction is community and relationship.

    And one of the things that this takes away from us is that relationship.

  • Stephanie Sy:

    It's why Loyd has also fought to keep the treatment facilities he helps oversee in three states open during the pandemic.

    As chief medical officer, Dr. Loyd has instituted a have safety protocols, including testing his own staff, isolating any positive cases in residential facilities, and frequent temperature checks.

  • Stephen Loyd:

    We're more crucial now than we have ever been. The folks suffering with addiction are more marginalized right now than they have ever been. And we have to be there with meaningful treatment that can help them to the best of our ability, as our worlds get turned upside down.

  • Stephanie Sy:

    Even with the pandemic turning the world upside down, Dr. Loyd has been able to expand his reach because of the relaxed telehealth rules, which he now says should be made permanent.

    For the "PBS NewsHour," I'm Stephanie Sy.

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