Experts warned that drug and alcohol addictions were likely to increase during the coronavirus pandemic and they appear to be right: In New Jersey, overdose deaths rose 17% over last year by July.
While the gap has lessened some since then, an NJ Spotlight analysis of state statistics suggests that the state could be on track to end 2020 with a record number of fatalities related to alcohol, opioids and other drugs. Nearly 1,600 residents lost their lives to overdose between January and the end of June.
“I have friends who have OD’d and died during COVID,” said Justin Hillman, a Bergen County man now in recovery with the help of CarePlus New Jersey, based in Paramus. With the isolation required in the lockdown and the stress related to the virus, “you just have a lot of time to sit and stew. And for people with addictions, your idle hours are the worst.”
Research has shown that economic declines, rising unemployment and social upheaval correspond with rising rates of drug use. Early in the pandemic, addiction treatment providers in New Jersey witnessed a surge in demand because of increased need and pandemic-related restrictions that had forced some facilities to scale back programs.
As the impact of the virus has ebbed and the state begins to reopen, some addiction programs — including CarePlus — have been able to expand services, including the use of telehealth. Others have struggled to adopt new technology or convert their facilities in ways that can accommodate socially distanced treatment sessions.
The state has sought to support these efforts. The Department of Human Services made regulatory changes to improve access to care, offered advance payments to certain treatment agencies and committed $25 million in federal funds to help providers cover new, coronavirus-related costs. The DHS is also planning to distribute free doses of naloxone, the opioid-overdose reversal agent, in conjunction with more than 300 local pharmacies at the end of next week. Another $7.1 million from the federal Centers for Disease Control and Prevention will be used to fund various efforts to reduce overdose deaths, according to state officials.
Extra funding ‘at a critical time’
“This funding comes at a critical time as we are concerned about an increase in overdose deaths that have occurred this spring,” state Department of Health Commissioner Judy Persichilli said when the overdose prevention dollars were announced on Aug. 31, in conjunction with International Overdose Awareness Day.
“Although the pandemic has taken over front-page news, the opioid epidemic is still as critical as it has ever been,” Persichilli said at a legislative hearing Monday. COVID-19 has been diagnosed in nearly 197,000 residents, including at least 14,200 who have died. At the same time, she said, “we have to keep our eye on the ball when it comes to the opioid overdose dilemma.”
New Jersey is certainly not alone in experiencing a rise in drug-related fatalities. Overdose deaths were up 13% nationwide over last year during the first six months of 2020, The New York Times reported, with fatalities leaping as much as 60% in Delaware.
But New Jersey is one of a dozen states — along with neighboring New York and Pennsylvania — flagged by the Commonwealth Fund for a high rate of overdoses and rising unemployment, indicators that the nonprofit group said exacerbate the challenges for opioid response efforts. According to the researchers, unemployment increased 10.5% in New Jersey between July 2019 and July 2020.
If the overdose death rate recorded in New Jersey during the first six months of the year continues, nearly 3,200 people could suffer fatal overdoses by the end of December, the highest annual total in at least eight years. The previous high mark, 3,118 deaths, was recorded in 2018; 3,021 residents overdosed last year. In recent years, drug-related fatalities have ticked up in the fourth quarter; if this trend repeats, the 2020 death toll could be even greater.
Debra Wentz, president and CEO of the New Jersey Association of Mental Health and Addiction Agencies, which represents providers, said pandemic and economic-related stress certainly is driving up drug and alcohol use, including among elderly people who may have become even more isolated than before. “People have met their tipping point,” she said. “There’s a sense of escapism” in drugs and alcohol, she noted.
‘New population with new needs’
Providers are looking for ways to meet the increased demand for services, Wentz said. “You have a new population with new needs, and that’s definitely going to continue. And if there’s a second wave [of COVID-19 cases], it’s going to impact people even further,” she said.
Officials at the human services department, which oversees community-based mental health and addiction programs, appeared to have acknowledged this potential in Gov. Phil Murphy’s $32.4 billion nine-month budget proposal, which lawmakers must approve before Oct. 1. The plan allocates at least $10 million more for addiction services grants compared to last year, and anticipates that demand for treatment will top 106,800 placements at residential, outpatient or detox programs, more than 3,700 more slots than were needed this year.
Some treatment programs, like CarePlus, have already beefed up client capacity by developing telehealth options — which was not permitted for many addiction services before the pandemic — and adding staff. That included the hiring of Dr. Jerry Joseph, a vice president of addiction medicine.
“We’ve kind of increased our bandwidth,” Joseph said. “We meet people where they are and try to work with them as best we can.”
Like all health care facilities, CarePlus now requires masks, temperature checks and symptom screenings for clients entering its facilities, Joseph said. And it secured smartphones for individuals who wanted to try telehealth but lacked the right technology. Providers also opted for telephone follow-ups for some visits that previously were done in person, he explained, and wraparound services to help clients with job training, accessing public benefits and other tasks that are particularly important now.
“I think the vast majority of patients see (the use of telehealth) as an improvement, or a positive,” Joseph said. “We’re able to engage our patients and follow up a bit better.”
Hillman, who said he hasn’t abused opioids for a year and nine months, was among those able to embrace the new technology. “At first I was very hesitant and I thought a lot would be lost in translation. And I’m younger — I’m used to FaceTime and all that,” the CarePlus client said. “But after a few sessions I realized it was working really well. Now I look forward to the appointments every week.”
Telehealth effective, but not for all
But Wentz, with the mental health and addiction agencies’ association, noted that these changes have not worked well for all providers or clients. The nonprofit has worked with member agencies to help them set up telehealth programs, which were a challenge for some smaller organizations. “Telehealth has been really effective,” she said, “but not all individuals were comfortable with it.”
Some treatment programs had more physical space, or multiple locations, that allowed them to create distance between individuals attending group sessions or waiting for counselors, Wentz explained. “Others had a much more circumscribed universe in terms of their physical plant and their funding for expanding capacity,” she said.
Treatment programs — generally paid on a fee-for-service basis — also faced financial losses when clients who feared the virus or started using drugs again stopped coming to sessions, Wentz said. Some lost up to 25% of their normal revenue during the second quarter, she said, because of a decline in business.
“The census was down and it’s really tough for providers,” she said. “They’re cutting staff at a time when, with social distancing, you need to extend staffing hours” so clients aren’t crowded in a facility at the same time, she added, noting that these changes are also stressful for staff.
“We’re all still straddling two worlds,” Wentz said of the current mix of onsite and online programs.