The isolation and stress brought on by COVID-19 have been particularly difficult for people fighting drug addiction. When Ohio shut down in March, nonprofits that offer services to people with substance use issues had to change the way they operate to keep the virus at bay.
MetroHealth, which operates an opioid safety office, also had to limit some services.
“With COVID 19 happening the way it did… access to treatment, detox, all of that shut down,” said Kelly Cioletti.
Cioletti, a social worker, said that MetroHealth's Quick Response Team had to regroup. The team decided to use the Project Dawn RV to offer some services, such as the overdose reversal drug naloxone, clean needles and fentanyl test strips.
The mobile unit is parked in a lot across from the MetroHealth main campus on West 25th Street in Cleveland, and is open limited hours during the week.
A 36-year-old Cleveland man, who asked that we not use his name, came to the RV recently to get help. It’s been a difficult time for people with substance use issues, he said.
“The people that run these programs have made sure that these lifesaving services are available,” said the man, who's used drugs for several years.
There are some barriers, however, for people who might want to get to the MetroHealth RV.
“You know you have to be able to get here, and you can’t really social distance when you are using public transportation,” he said.
MetroHealth is not alone in struggling to continue to provide services.
Stella Maris in the West Flats is a well-known detox center. The agency quickly moved many of its drug counseling sessions to telehealth visits and capped in-patient treatment, said executive director Daniel Lettenberger-Klein.
“We reduced our capacity in our detox from 20 beds down to 12 so that we could ensure appropriate physical distancing," said Lettenberger-Klein. "And so that lowered our ability to take care of clients."
Stella Maris also offers short-term housing for those in recovery.
“We have a 46-bed men's dormitory on campus," he said. "We are only admitting (to the dormitory) through our detox, so that we had the appropriate amount of time to screen clients to ensure we weren't possibly infecting more people."
People were staying away, deferring help, because they were afraid of contracting the virus if they came to the detox unit.
“I would say from mid-March to mid-April, we went from averaging 50-70 phone calls a day for detox alone, down to single digits,” Lettenberger-Klein said.
Many groups that host 12-step meetings, such AA, also use the Stella Maris building and were forced to move to video meetings. As the crisis hit, some who needed those meetings were not able to overcome the technology barriers, said Lou LaMarca, clinical director at Community Assessment and Treatment Services (CATS).
LaMarca, whose Slavic Village-based agency helps people on probation, said that things happened so quickly, it took a while for the 12-step groups to work out all the kinks. That left some without needed support.
“Most people in recovery have a relapse prevention plan where they identify stressors that they're likely to face and what they can do to maintain their sobriety throughout it," LaMarca said. "No one's relapse prevention plan had worldwide pandemic on it."
Some people did relapse because they lacked the skills to cope with the unprecedented stressors they we're facing, he said.
While some vital addiction services were getting cut back, so were the supplies of drugs in the local area, said Larry Smith, director of programs at the Cuyahoga County ADAMHS Board.
It was an uncertain time for everyone so people hunkered down at home. And many drug dealers were not able to get their usual supply, he said.
“Some of the drugs weren't as available," Smith said. "And so a portion of alcoholics and addicts just took a pause and they slowed down. And now I think that as people are getting more used to these routines — I hope they don't pick up, but more folks will be out there doing what they do."
Things have unfortunately picked up, according to Cuyahoga County Medical Examiner Dr. Thomas Gilson. There has been a stark increase in recent overdoses.
Gilson issued a recent public health alert as the county experienced nine deaths attributed to drug overdoses in the 48-hour period between May 16-19. Gilson said he thinks people who stopped using while quarantined at home are now, as the state opens back up, going back to using drugs at the same pace as before.
"Maybe those are the folks who [are using] a level of drug that they thought they could handle back in February or January, but in May, it's too much,” he said.
Officials at St. Vincent Charity Medical Center are preparing for what may be a surge of people who need both mental health and addiction services as Ohio opens up, said chief clinical officer Dr. Michael Biscaro.
“We don't really know what's happening to people out there," Biscaro said. "And I think we're about to find out. What the mental health and addiction community is trying to prepare for is that surge because we know that, amidst an epidemic, amidst a crisis or a tragedy, there is almost always a spike in mental health symptoms, trauma reactions, addictions."
And with an ongoing pandemic, drug treatment providers will have to continue to get creative about how to adapt their response.