LEXINGTON, Ky. – Substance and alcohol use in Fayette County is surging as the COVID-19 pandemic creates challenges to healthcare systems and public health policies with regard to prevention strategies.
Requiring novel treatment and preventative measures to adapt, individuals with substance and alcohol use disorders are not only an at-risk population for contracting the coronavirus but also are more susceptible to relapse or overdose because of the sudden social and economic changes caused by the pandemic, in addition to the traditional difficulties of treatment access and adherence.
Following global and national trends, overall substance and alcohol use, overdoses and overdose deaths have increased significantly in Fayette County since the pandemic began. Addiction specialists attribute the trend upward to the isolation created by lockdowns implemented because of the pandemic, fear, unemployment, social distancing requirements and other factors.
Several indicators are used to determine if there is an increase in drug use, and one is the number of people using the needle exchange program, which was created to prevent the spread of hepatitis C and HIV among drug users. John Moses, team leader of harm reduction services at the Lexington-Fayette County Health Department and supervisor of its nearly five-year-old needle exchange program, said he has noticed a steady increase in participants in the four months since the pandemic began.
“The needle exchange is an anonymous program, so we don't know for sure if participants are coming more frequently,” Moses said. “But we're seeing an increase of about 80 people each month coming through the exchange for the first time.”
Amy Baker, substance use intervention program coordinator for the city of Lexington’s Substance Use Disorder Intervention Program, which is a resource for individuals in search of information about substance use, addiction and treatment services, said an average of 230 people used the needle exchange program each week before the pandemic and that number exploded to nearly 500 during the third week of July.
“Addiction is just a monster,” she said. “I was crushed when those numbers came out.”
Drug-users are part of a population that is already marginalized and experiences a lot of isolation, and COVID-19 has increased that isolation, Moses said. Contributing also to the increase in the number of participants using the needle exchange program is pandemic-related job loss.
“We think maybe people who were only normally using drugs on the weekend and working during the week are now doing drugs full time,” Moses said. “And what happens when there's a pandemic or something like this is an interruption in the drug supply coming from Mexico, and that has led to more fentanyl coming in. We have seen a dramatic increase in overdose deaths because of fentanyl.”
Fentanyl is a powerful synthetic opioid analgesic similar to morphine but 50- to 100-times more potent. It is a Schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery.
“We have people who I think are doing methamphetamine, but it's laced with fentanyl,” Moses said. “The same thing with cocaine and heroin – just about all of the drugs in Lexington right now have fentanyl in them.”
Baker said fentanyl bears a striking resemblance to Xanax, another widely abused drug. Dealers will purchase a pill press from the internet and stamp a Xanax imprint on bars of pure fentanyl.
“A person could take a Xanax and probably be OK even if it knocked them out,” Baker said. “But that much fentanyl is going to kill the majority of people who take it because humans just don't have a tolerance for something that strong. The overdose deaths in 2017, our peak year, were primarily opioid-related. At that point, we were seeing fewer pills in Fayette County and more heroin. So now there's a new player in all of this with fentanyl.”
Another statistic used to determine an increase in substance use is the number of overdose calls responded to and NARCAN kits administered by emergency medical service personnel, and overdoses in 2020 are on pace to be the most in the history of Fayette County. By the end of May in 2019, Fayette County emergency medical personnel had responded to 359 overdose calls and administered 536 doses of NARCAN, a naloxone formulation administered as a nasal spray to treat known or suspected opioid overdoses. By the end of May this year the number of calls was at 587 and NARCAN doses at 895. Final numbers for June are not yet available, but Baker said it looks as though there may be a slight trend downward.
“I 100 percent believe we are seeing more overdoses because folks are in emotional pain, there's fear, there's anxiety, there's lack of structure, there's lack of connection, there's lack of socializing with folks,” she said. “None of that is good for early recovery.”
A report released by the White House drug policy office estimated Kentucky had a 25 percent increase in overdose deaths from January to March while other state data show a rise in emergency department visits and EMS calls connected to overdoses increasing between March and June.
Svetla Slavova, co-director of the federally funded Kentucky HEALing Communities data study, told politico.com Kentucky began seeing a significant increase of roughly 14 additional EMS opioid overdose runs every week on average after President Trump declared a public health emergency because of COVID-19 on March 13, with EMS overdose runs in the first week of April marking the highest on record in the past two years.
Recovering addict Scott Luallen is a peer-support specialist who specializes in overdose prevention for the Substance Use Disorder Intervention Program. He celebrated his eighth year of sobriety this past October and said addicts are always vulnerable and the pandemic has made things more difficult.
“People are clinging to whatever support they had, if any, then the whole bottom drops out and creates a lot of helplessness and fear,” he said. “For whatever reason, recovering addicts will pick back up and remember the ease and comfort that comes from a drink, drug or whatever it is. Since they're not plugged in and can’t go to meetings, maybe they don't have their job and they can't see their family, so they get a sense of isolation and get in touch with the dope man or go to the liquor store and it's pretty much game over.”
Luallen’s position with the city of Lexington is funded through a four-year grant from the Substance Abuse and Mental Health Services Association, or SAMHSA, and one aspect of his job is doing community outreach and distributing NARCAN kits. He regularly hands out the kits at the Lexington-Fayette County Health Department, the New Day Life Center homeless shelter, the Lexington Rescue Mission and Lighthouse Ministries. He said he has not been to New Day Life Center or Lighthouse Ministries since the pandemic began, and only recently resumed his visits to the Lexington Rescue Mission.
“The pandemic has interrupted everything,” he said. “I've been able to talk to people on the phone and there's been zoom meetings and all that, but you know, human beings need a connection. We just do; there's no way around it. We need face-to-face interaction and to have a hug and all that stuff.”
In 2013 there were 81 overdose deaths in Fayette County. There were 108 in 2014, 137 in 2015 and 162 in 2016. Fayette County experienced the most overdose fatalities in 2017 with 187. After declines in both 2018 and 2019 with 168 and 121, respectively, there has been a 42 percent increase in 2020 with 107 overdose deaths and several more pending by the end of May.
“It's happening in many places, but we're focusing on Fayette County, and we wanted to do whatever we could do to get in front of that,” Baker said. “Our fear is with the increase that we're seeing our overdose deaths this year will exceed the 187 overdose fatalities we had in 2017. Fayette County has a lot of folks working together trying to address this at every angle. We were over the moon because of the significant decrease from 187 overdose deaths in 2017 to 128 in 2018. Then I learned of the first numbers from January to April of this year, and they had increased significantly from where we were in 2019 and we still have the rest of the year and a pandemic that seems to be getting worse. We have got to find ways through this and to safely find ways for folks to connect again.”
Baker said Eastern Kentucky has been significantly affected by opioids and the area has experienced a great deal of loss during the corona period, including a peer support worker who died of overdoses while working in the field.
“This problem is not specific to Lexington; it's happening in other places as well,” she said. “But the very thing that protects us from acquiring the coronavirus – isolation from basically everything – is very counterproductive to recovery, which requires a connection. Addiction thrives in isolation.”
Baker said pandemic-related social distancing guidelines stopped all in-person 12-step meetings. Although virtual 12-step meetings continue taking place, many people struggling with substance use disorder do not use smartphones or have internet access. With libraries also closed, addicts that depended on human connection as part of their recovery discovered that element was no longer available.
Many addicts use methadone to recover from opioid addiction, but the pandemic also changed the federal guidelines dictating how the medication can be prescribed.
“For decades, if you were on methadone, you had to go to your treatment provider every morning, get your medicine and leave,” Baker said. “There are people that for years got up at 6 a.m., got their medication by 7 a.m., and went from there to work or college or however they were keeping their life together on their medication. All of a sudden, even that stopped. Regulations changed and now allow people to take home up to 28 days of methadone, which after being in this field for 20 years, I had never even heard of. I couldn't believe it. So imagine losing all of your support and connections, then add on anxiety, fear and potential job loss. It's been a very scary time.”
Luallen also said the methadone guidelines implemented as a result of the pandemic make that process problematic.
“Methadone routines interrupted using drugs, so that person will just go back to using because they know they can get dope,” he said. “A program, whatever it might be – medically assisted treatment, outpatient or whatever – is often the only stable factor in a recovering addict’s life with people they were getting to know, such as therapists, counselors or the other clients in the program. For many it was their only support and got taken away.”
Luallen said he is fortunate to have his support system, but the pandemic and its associated lockdowns, quarantines, social distancing and other guidelines are detrimental, especially to addicts early in the recovery process.
“Somebody who is early in recovery, they're just they’re behind the eight ball,” he said. “If I was in their shoes, I can tell you this would be tough – I can't imagine trying to negotiate this. Some people have remained sober and clean through this and some haven’t. Some people are more resilient than others and some have more resources. Every situation is unique.”
A significant part of recovery and one of the more successful methods is cognitive behavioral therapy, which is a common type of psychotherapy during which one works with a mental health counselor in a structured way to become aware of inaccurate or negative thinking so one can view challenging situations more clearly and respond to them more effectively. Those types of programs for addicts have been either significantly altered or stopped altogether because of the pandemic.
“Cognitive behavioral therapy gets you in a routine of doing things that foster a positive mindset and includes going to meetings,” Luallen said. “It instills certain behaviors and replaces your old way of life. If that gets interrupted then it's detrimental.”
Just as the pandemic has changed the way addicts approach recovery, the same is true for the addiction specialists charged with implementing the process. Sidney Sebastian, supervisor of counseling services at addiction treatment center 2nd Chance PLLC in Lexington, said she has seen an increase in substance use during the pandemic because treatment facilities have shut down and other community resources, such public transportation and the Medicaid bus often used by recovering addicts, have adopted capacity guidelines or temporarily ceased operations. The concept of isolation and 12-step meetings not being in person have also contributed to the problem. She also noted an increase in first-time users and drug-related criminal activity could be a result of the pandemic.
“People who have lost their job as a result of the pandemic could resort to criminal activity such as dealing drugs because they still have to feed their families, which makes the availability of drugs more prevalent,” she said. “Everyone, whether an addict or not, has some difficulty adapting to change, and there have been huge changes across the board during the pandemic.”
Sebastian said 2nd Chance has a comprehensive behavioral health team now offering more telehealth options for recovery and the center is experiencing an increase in patients likely being absorbed from other facilities and programs.
“We have accepted the idea that COVID is likely going to be around longer than was originally anticipated and we are adapting to accommodate the best we can,” she said. “2nd Chance had never used telehealth before and we are thinking on our feet and learning to adapt on the fly.”