As COVID-19 paused 12-step meetings all over the country, an explosion of online meetings and new virtual support resources sprung up in their place. People in recovery pioneered a new kind of support that is immediately accessible, anytime, anywhere.
We were able to hop online at any hour and go to a meeting in New York, Cleveland, London, or Bangkok. Many of our friends, some that are new to recovery, have called the flood of new online resources the best thing that has happened to them.
As the pandemic recedes, its full impact on people with substance use disorders is only beginning to come to light: the Centers for Disease Control and Prevention estimates that more than 92,000 Americans died of an overdose in the 12 months ending in November 2020, the highest number ever recorded, and 20,000 more people than in 2019.
The professional network of systems treating people with substance use disorders, from rehabs to courts, should combat these skyrocketing numbers by taking their cues from the recovery community’s response—people struggling with addiction need immediate and unconditional access to help and support.
For people taking steps toward recovery, getting help is too often an arduous, multi-step endeavor. “Treatment” can involve dozens of separate steps, from withdrawal management to medication, often delivered by different providers in multiple locations. Services are often accessible only if a person knows where to go, has a way to pay, can get services in their language, and has a way to get there in the first place.
Recovery is often treated like something that can be scheduled: an intake appointment in two weeks, housing in six weeks (or six months, or never). Even though addiction is a chronic illness, positive drug screens often result in punishment, with life-altering setbacks like jail time or eviction, and on and on.
People often only have access to services if they prove they can jump through all the hoops and demonstrate they are worthy of services by staying sober.
Recovery doesn’t work like that. People need support right when they are ready, or that window closes and people die. Virtual resources are one way to provide instant availability of the right kind of support. COVID-19 has created the opportunity to innovate and re-imagine the systems treating addiction.
In response to the need for access to addiction services in the COVID-19 public health emergency, federal and state agencies have waived regulations on telehealth, medication access, reimbursement and more to make it easier to access treatment and support.
There is new federal legislation to make many of these changes permanent. A report by researchers at the George Washington University (GWU) Regulatory Studies Center found that the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration (SAMHSA) have the legal authority to extend many of these protections, even without changes to federal law.
Relaxing these rules and others is the starting point for providing care in the moment someone needs it, even once the COVID crisis passes. The response to COVID-19 opened doors to a more streamlined system—and those doors should stay open.
Of course, the internet doesn’t provide all the answers – many people do not have access to a phone or a computer, or a private and safe place to talk. And, enhanced use of technology magnifies the need to maintain and bolster the strict privacy and consent standards that enable the trust required in a therapeutic relationship. This is not the time to loosen confidentiality regulations and expose people to stigma when technology can provide the necessary protections and solutions.
The COVID crisis does, however, highlight issues that technology has the potential to solve, especially for people facing transportation issues and financial challenges, people with disabilities who may not easily be able to travel, and people in rural areas with limited access to services.
Telehealth is not a panacea, it is one an example of a previously untapped resource. The COVID-19 crisis shines a light on all the pieces of our fragmented systems. It has exacerbated the conditions that mental health disorders and addiction thrive in, like loss of income, housing insecurity, the impact of incarceration, and trauma—and further highlights the disproportionate impact of all these on communities of color and people who are already struggling to make ends meet.
Our systems need to adjust to help people, not the other way around.
We can start by centering systems on the needs and experiences of people with mental health conditions and substance use disorders, our families, and communities. Easy initiation of treatment and medication; seamless payment and provision of services; weaving housing, food, and economic mobility into the fabric of our systems; addressing the pervasive racial disparities in access to treatment; ensuring equitable access to care and technology; social connection; purpose—these are some of the potential pillars of a re-imagined system.
COVID-19 has shown us that, when the political will is there, we can cut through the bureaucratic barriers and get people what they need. We must apply this same approach to the epidemics we are already battling.
Shelly Weizman is the associate director of the Addiction and Public Policy Initiative at the O’Neill Institute and adjunct professor of law at Georgetown University Law Center. She is the former assistant secretary for mental hygiene in the Office of the Governor of New York and is a person in long-term recovery.
Danielle Tarino is an adjunct professor at the Georgetown Graduate School of Arts and Sciences’ new Master of Science in Addiction Policy & Practice. She is a former health IT team lead at the Substance Abuse and Mental Health Services Administration (SAMHSA) and a nationally recognized expert in privacy and confidentiality. She is also a person in long-term recovery.
