1 00:00:04,840 --> 00:00:10,280 Speaker 1: Welcome to Prognosis. I'm Laura Carlson. It's day forty since 2 00:00:10,360 --> 00:00:16,160 Speaker 1: coronavirus was declared a global pandemic. Our main story, opioid 3 00:00:16,160 --> 00:00:20,480 Speaker 1: addiction had ravaged large parts of the country before coronavirus 4 00:00:20,560 --> 00:00:25,040 Speaker 1: came along. Now those in recovery face a double whammy 5 00:00:25,079 --> 00:00:30,360 Speaker 1: from the outbreak, increased vulnerability to the illness, and limits 6 00:00:30,400 --> 00:00:33,519 Speaker 1: on addiction treatments that can only be done in person. 7 00:00:34,720 --> 00:00:48,720 Speaker 1: But first, here's what happened today. Democrats and the Trump 8 00:00:48,720 --> 00:00:51,840 Speaker 1: administration are racing to finish a deal for a nearly 9 00:00:52,080 --> 00:00:56,840 Speaker 1: five hundred billion dollar interim coronavirus rescue package in time 10 00:00:56,880 --> 00:01:00,400 Speaker 1: for Congress to approve it this week. The two signs 11 00:01:00,440 --> 00:01:03,960 Speaker 1: have yet to hammer out many of the details. Democrats 12 00:01:03,960 --> 00:01:07,880 Speaker 1: and Republicans disagree about a formula to distribute health care 13 00:01:07,920 --> 00:01:12,560 Speaker 1: aid to states and which agency should oversee a stepped 14 00:01:12,600 --> 00:01:16,440 Speaker 1: up testing program. According to people familiar with the discussions, 15 00:01:17,480 --> 00:01:20,840 Speaker 1: the package would inject billions into the tapped out paycheck 16 00:01:20,880 --> 00:01:25,280 Speaker 1: Protection program, which aims to help small businesses keep paying workers. 17 00:01:26,200 --> 00:01:29,840 Speaker 1: The SBA program has already exhausted the three hundred and 18 00:01:29,840 --> 00:01:34,000 Speaker 1: fifty billion dollars it was allotted. Just weeks ago. It 19 00:01:34,120 --> 00:01:38,280 Speaker 1: also includes funding for hospitals, particularly in rural areas, and 20 00:01:38,360 --> 00:01:42,640 Speaker 1: a testing program. Over the weekend, a handful of small 21 00:01:42,680 --> 00:01:46,880 Speaker 1: protests against lockdown measures were met with support by President 22 00:01:46,920 --> 00:01:51,160 Speaker 1: Donald Trump. That support goes against the guidance of his 23 00:01:51,280 --> 00:01:57,000 Speaker 1: own administration's experts. Dr Anthony Fauci, the country's top infectious 24 00:01:57,040 --> 00:02:01,400 Speaker 1: disease expert, said today that reopening WHO soon would damage 25 00:02:01,520 --> 00:02:04,880 Speaker 1: the economy in the long run, not just public health. 26 00:02:05,880 --> 00:02:09,600 Speaker 1: Faucia was asked on ABC's Good Morning America to respond 27 00:02:09,639 --> 00:02:13,639 Speaker 1: to protesters who resisted stay at home orders with chants 28 00:02:14,080 --> 00:02:19,920 Speaker 1: of fire. Fauci, Clearly, this is something that is hurting 29 00:02:20,400 --> 00:02:23,640 Speaker 1: from the standpoint of economics, from the standpoint of things 30 00:02:23,639 --> 00:02:26,720 Speaker 1: that have nothing to do with the virus. But unless 31 00:02:26,760 --> 00:02:31,200 Speaker 1: we get the virus under control, the real recovery economically 32 00:02:31,320 --> 00:02:34,040 Speaker 1: is not gonna happen. So what you do, if you 33 00:02:34,200 --> 00:02:37,040 Speaker 1: jump the gun and go into a situation where you 34 00:02:37,080 --> 00:02:40,600 Speaker 1: have a big speed spike, you're gonna set yourself back. 35 00:02:41,360 --> 00:02:46,400 Speaker 1: It's gonna backfire. That's the problem. In Germany, which has 36 00:02:46,440 --> 00:02:49,920 Speaker 1: been more successful than the US at limiting the outbreak spread, 37 00:02:50,639 --> 00:02:54,679 Speaker 1: Chancellor Angela Merkel also warned that the country shouldn't move 38 00:02:54,680 --> 00:02:58,840 Speaker 1: too quickly to ease up on social distancing measures. The 39 00:02:58,919 --> 00:03:02,000 Speaker 1: Chancellor said that raises the risk of ending up with 40 00:03:02,040 --> 00:03:07,880 Speaker 1: an even stricter national lockdown. In remarks on Monday, she 41 00:03:07,960 --> 00:03:10,799 Speaker 1: said the country has made progress but not yet reached 42 00:03:10,840 --> 00:03:14,960 Speaker 1: its target. Cases in Germany rose Monday by the smallest 43 00:03:15,000 --> 00:03:25,079 Speaker 1: amount this month, and now for today's main story. Before 44 00:03:25,200 --> 00:03:28,920 Speaker 1: COVID nineteen started spreading around the US, the country was 45 00:03:28,960 --> 00:03:33,639 Speaker 1: already attempting to deal with another health crisis, opioid dependency. 46 00:03:34,920 --> 00:03:39,480 Speaker 1: Although opioid treatment programs are considered essential public facilities and 47 00:03:39,600 --> 00:03:43,240 Speaker 1: are allowed to stay open during statewide stay at home orders, 48 00:03:44,040 --> 00:03:48,520 Speaker 1: experts are worried the coronavirus could exacerbate the opioid epidemic, 49 00:03:49,080 --> 00:03:54,760 Speaker 1: possibly leading to more overdoses. Producer Jordan Gospure looked into 50 00:03:54,760 --> 00:03:59,600 Speaker 1: how clinics and federal regulations are adapting to meet the 51 00:03:59,680 --> 00:04:05,880 Speaker 1: knee of patients. For some patients with opioid use disorder, 52 00:04:06,320 --> 00:04:09,840 Speaker 1: getting their daily dose of methadone, the prescription drug typically 53 00:04:09,920 --> 00:04:12,960 Speaker 1: used to treat opioid dependency, is an essential part of 54 00:04:13,000 --> 00:04:16,920 Speaker 1: their lives, but now standing in line or being in 55 00:04:16,960 --> 00:04:20,560 Speaker 1: a crowded waiting room at an outpatient treatment program could 56 00:04:20,600 --> 00:04:25,400 Speaker 1: increase the risk for COVID nineteen infection. Dr Sue Kim 57 00:04:25,480 --> 00:04:28,919 Speaker 1: is the medical director of the Harm Reduction Coalition and 58 00:04:29,000 --> 00:04:33,479 Speaker 1: an addiction medicine attending physician. We know that people who 59 00:04:33,600 --> 00:04:37,880 Speaker 1: use drugs are often they could be at higher risk 60 00:04:37,960 --> 00:04:41,760 Speaker 1: for acquiring this, or they might have conditions that predispose 61 00:04:41,839 --> 00:04:46,200 Speaker 1: them to doing poorly if they do acquire covid um 62 00:04:46,240 --> 00:04:56,039 Speaker 1: So it's it's a very difficult situation. Those with opioid 63 00:04:56,080 --> 00:04:58,560 Speaker 1: use disorder are already more at risk of homelessness and 64 00:04:58,600 --> 00:05:02,800 Speaker 1: incarceration than those the general population. Now they may be 65 00:05:02,880 --> 00:05:06,440 Speaker 1: enabled to get necessary medications and treatments vital to the recovery. 66 00:05:07,480 --> 00:05:10,320 Speaker 1: In the US, methodone can only be dispensed at highly 67 00:05:10,320 --> 00:05:14,200 Speaker 1: regulated and monitored opioid treatment programs. There are nearly two 68 00:05:14,200 --> 00:05:17,080 Speaker 1: thousand of these programs across the country that see thousands 69 00:05:17,080 --> 00:05:21,560 Speaker 1: of patients. Many patients taking methodone or the prescription bupenorphine 70 00:05:21,600 --> 00:05:24,240 Speaker 1: to treat their opioid use disorder aren't able to stay 71 00:05:24,279 --> 00:05:27,440 Speaker 1: at home because of strict government regulations that limit the 72 00:05:27,480 --> 00:05:32,160 Speaker 1: way these medications are prescribed and dispensed. Before the coronavirus pandemic, 73 00:05:32,400 --> 00:05:35,680 Speaker 1: Some patients over time were able to take home a 74 00:05:35,760 --> 00:05:38,280 Speaker 1: limited number of doses because they gained the trust of 75 00:05:38,320 --> 00:05:41,280 Speaker 1: the clinic, but even the most trusted patient generally had 76 00:05:41,320 --> 00:05:43,360 Speaker 1: to return to the clinic or pharmacy once a week 77 00:05:43,440 --> 00:05:47,840 Speaker 1: for a supervised dose. The federal government temporarily relaxed restrictions 78 00:05:47,839 --> 00:05:49,760 Speaker 1: in March for some patients to take home up to 79 00:05:49,800 --> 00:05:52,720 Speaker 1: a month's worth of their daily methodone or bupanorphine doses, 80 00:05:53,160 --> 00:05:57,400 Speaker 1: depending on their stability and treatment. Addiction advocates have along 81 00:05:57,480 --> 00:06:00,160 Speaker 1: pushed for these changes, and research shows at making inti 82 00:06:00,160 --> 00:06:05,479 Speaker 1: addiction medications more easily available cuts opioid overdoses in half. Still, 83 00:06:05,760 --> 00:06:09,039 Speaker 1: even during a pandemic, Dr Kim says clinicians are leery 84 00:06:09,080 --> 00:06:12,120 Speaker 1: about giving patients take hoome doses because they're afraid they'll 85 00:06:12,120 --> 00:06:17,120 Speaker 1: be lost, stolen, sold early to an overdose. And these 86 00:06:17,160 --> 00:06:21,200 Speaker 1: clinics are are each operating into you know, they might 87 00:06:21,279 --> 00:06:25,000 Speaker 1: operate independently, but they are all overseen by particular state 88 00:06:25,040 --> 00:06:28,880 Speaker 1: opioid treatment authority who dispenses the kind of the advice 89 00:06:28,920 --> 00:06:31,720 Speaker 1: and the regulations. But it needs to trickle down to clinics, 90 00:06:31,720 --> 00:06:33,880 Speaker 1: and clinics end up having to make a lot of 91 00:06:33,920 --> 00:06:41,800 Speaker 1: decisions for their patients. It's incredibly complex. Opioid treatment facilities 92 00:06:41,839 --> 00:06:44,680 Speaker 1: around the country have had to change the rehabilitation techniques 93 00:06:44,680 --> 00:06:48,200 Speaker 1: in the face of the coronavirus pandemic. New patients can 94 00:06:48,240 --> 00:06:51,360 Speaker 1: now be prescribed even orphine virtually or by phone, but 95 00:06:51,440 --> 00:06:54,520 Speaker 1: for people recovering from opioid used disorder, the new guidelines 96 00:06:54,520 --> 00:06:58,320 Speaker 1: have been inconsistent. There have been reports of some states 97 00:06:58,360 --> 00:07:01,200 Speaker 1: requiring patients with take hoom do is to come into 98 00:07:01,200 --> 00:07:05,360 Speaker 1: the clinic. Despite changes in federal guidelines. Other clinics are 99 00:07:05,360 --> 00:07:09,120 Speaker 1: having problems tracking the medications substance of use them into 100 00:07:09,160 --> 00:07:12,119 Speaker 1: Health services have finally issued some protocols in recent weeks. 101 00:07:12,160 --> 00:07:14,520 Speaker 1: That's starting to make some difference in what towns and 102 00:07:14,560 --> 00:07:17,440 Speaker 1: cities can do, but there's still a lot of confusion 103 00:07:17,520 --> 00:07:20,400 Speaker 1: and a lot of fear. Even when a clinic is 104 00:07:20,560 --> 00:07:23,320 Speaker 1: business as usual, those patients who pay cash for their 105 00:07:23,320 --> 00:07:26,800 Speaker 1: medication are unable to afford more than their daily prescription. 106 00:07:27,480 --> 00:07:30,440 Speaker 1: I recently spoke with Melissa Dunford, who started the Faces 107 00:07:30,440 --> 00:07:33,480 Speaker 1: of Opioids Facebook group in sen for those who have 108 00:07:33,520 --> 00:07:36,840 Speaker 1: been affected by the epidemic after a friend fatally overdosed 109 00:07:37,280 --> 00:07:39,280 Speaker 1: she's heard stories from some of the members who have 110 00:07:39,360 --> 00:07:41,920 Speaker 1: no recourse but to find the money or forego life 111 00:07:41,920 --> 00:07:45,680 Speaker 1: saving treatment. What we're finding is one our cash patients 112 00:07:45,800 --> 00:07:47,960 Speaker 1: are hosed or screwed over because they might not have 113 00:07:48,080 --> 00:07:50,440 Speaker 1: money to pay for a thirty day supply and go 114 00:07:50,520 --> 00:07:53,680 Speaker 1: home with it. So one woman was told, sorry, get 115 00:07:53,680 --> 00:07:55,480 Speaker 1: the money, or you don't get your medicine and just 116 00:07:55,520 --> 00:07:58,480 Speaker 1: set out the door. Experts warn that COVID nineteen will 117 00:07:58,520 --> 00:08:01,880 Speaker 1: only worsen the opoid crisis. Workers at some opioid treatment 118 00:08:01,880 --> 00:08:05,560 Speaker 1: facilities don't have enough face masks and gloves, so these 119 00:08:05,560 --> 00:08:10,080 Speaker 1: programs are limiting their hours or shutting down completely. Online 120 00:08:10,080 --> 00:08:12,320 Speaker 1: help groups are working to fill these gaps, but there's 121 00:08:12,320 --> 00:08:15,160 Speaker 1: a risk that social isolation or an interruption to treatment 122 00:08:15,400 --> 00:08:17,640 Speaker 1: may make it harder for some people to stay in recovery. 123 00:08:20,240 --> 00:08:24,080 Speaker 1: Withdrawal sometimes mimics the symptoms of the coronavirus, so there's 124 00:08:24,080 --> 00:08:27,239 Speaker 1: a fear that physicians evaluating patients with opioid use disorder 125 00:08:27,320 --> 00:08:30,680 Speaker 1: will fail to identify cases of COVID nineteen. Staying at 126 00:08:30,720 --> 00:08:33,520 Speaker 1: home may increase feelings of depression and anxiety, and patients 127 00:08:33,800 --> 00:08:36,720 Speaker 1: who are at an increased risk of relapse and fatal overdose. 128 00:08:37,280 --> 00:08:39,719 Speaker 1: If they live alone and overdose, no one will be 129 00:08:39,800 --> 00:08:42,400 Speaker 1: there to administer no losin, the drug used to reverse 130 00:08:42,440 --> 00:08:47,600 Speaker 1: opioid overdoses, Further complicating the problem, if black market drug 131 00:08:47,640 --> 00:08:50,720 Speaker 1: supplies decrease, opioid dealers will be more likely to lace 132 00:08:50,800 --> 00:08:55,120 Speaker 1: drugs with other dangerous substances like fentyl. Dr Kim says 133 00:08:55,120 --> 00:08:58,160 Speaker 1: restrictions on movement may also prevent patients from buying drugs 134 00:08:58,160 --> 00:09:01,800 Speaker 1: from the regular dealer, so out of desperation, will buy 135 00:09:01,880 --> 00:09:04,920 Speaker 1: drugs from someone else. I've been concerned that a lot 136 00:09:04,920 --> 00:09:08,040 Speaker 1: of my patients who were managing to get money for 137 00:09:08,120 --> 00:09:11,680 Speaker 1: harrow and every day now don't have jobs. UM. So 138 00:09:11,840 --> 00:09:15,840 Speaker 1: you know, everyone is UH in the addiction communities keenly 139 00:09:15,920 --> 00:09:19,040 Speaker 1: aware of UM. Of how much we need to get 140 00:09:19,160 --> 00:09:21,920 Speaker 1: these medications to people, and how life saving they are, 141 00:09:22,640 --> 00:09:26,680 Speaker 1: and how we can need to be flexible and UM 142 00:09:26,720 --> 00:09:31,079 Speaker 1: and accommodating so UM and give an orphan and method 143 00:09:31,080 --> 00:09:34,600 Speaker 1: and are much safer, and we prefer people to beyond 144 00:09:34,600 --> 00:09:37,560 Speaker 1: those treatments. Health providers in the US are working to 145 00:09:37,600 --> 00:09:40,520 Speaker 1: make sure patients with opioid use disorder still have access 146 00:09:40,559 --> 00:09:44,640 Speaker 1: to treatment, even from a distance. As the coronavirus sweeps 147 00:09:44,640 --> 00:09:47,600 Speaker 1: across the country, closing businesses and forcing many people to 148 00:09:47,600 --> 00:09:50,920 Speaker 1: stay at home. Telehealth treatments are more important than ever. 149 00:09:51,760 --> 00:09:55,840 Speaker 1: Social isolation and an overburdened health system could undermine years 150 00:09:55,840 --> 00:09:58,720 Speaker 1: of progress officials have made in addressing the opioid crisis. 151 00:09:59,400 --> 00:10:01,720 Speaker 1: There are fear is that even once the coronavirus is over, 152 00:10:02,280 --> 00:10:04,679 Speaker 1: it will continue to have profound effects on people with 153 00:10:04,720 --> 00:10:22,040 Speaker 1: opioid use disorder. That was producer Jordan Gaspore. That's our 154 00:10:22,080 --> 00:10:25,120 Speaker 1: show for today. For more on the outbreak from one 155 00:10:25,520 --> 00:10:29,439 Speaker 1: and twenty bureaus around the world, visit Bloomberg dot com, 156 00:10:29,480 --> 00:10:34,679 Speaker 1: slash coronavirus and one Small favor. If you appreciate the show, 157 00:10:35,000 --> 00:10:37,680 Speaker 1: please leave us a review and a rating on Apple 158 00:10:37,720 --> 00:10:41,240 Speaker 1: Podcasts or Spotify. It's the best way to help more 159 00:10:41,320 --> 00:10:46,199 Speaker 1: listeners find our global reporting. The Prognosis Daily edition is 160 00:10:46,240 --> 00:10:49,760 Speaker 1: hosted by Me Laura Carlson. The show was produced by 161 00:10:49,800 --> 00:10:55,480 Speaker 1: Me Topher Foreheads, Jordan Gaspore, and Magnus Hendrickson. Today's main 162 00:10:55,559 --> 00:10:59,959 Speaker 1: story was reported by Jordan gas Poore. Original music by 163 00:11:00,120 --> 00:11:04,400 Speaker 1: Leo Sidran. Our editors are Francesco Levi and Rick Shine. 164 00:11:05,080 --> 00:11:09,280 Speaker 1: Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.