WEBVTT - The Other Epidemic 0:00:04.840 --> 0:00:10.280 Welcome to Prognosis. I'm Laura Carlson. It's day forty since 0:00:10.360 --> 0:00:16.160 coronavirus was declared a global pandemic. Our main story, opioid 0:00:16.160 --> 0:00:20.480 addiction had ravaged large parts of the country before coronavirus 0:00:20.560 --> 0:00:25.040 came along. Now those in recovery face a double whammy 0:00:25.079 --> 0:00:30.360 from the outbreak, increased vulnerability to the illness, and limits 0:00:30.400 --> 0:00:33.519 on addiction treatments that can only be done in person. 0:00:34.720 --> 0:00:48.720 But first, here's what happened today. Democrats and the Trump 0:00:48.720 --> 0:00:51.840 administration are racing to finish a deal for a nearly 0:00:52.080 --> 0:00:56.840 five hundred billion dollar interim coronavirus rescue package in time 0:00:56.880 --> 0:01:00.400 for Congress to approve it this week. The two signs 0:01:00.440 --> 0:01:03.960 have yet to hammer out many of the details. Democrats 0:01:03.960 --> 0:01:07.880 and Republicans disagree about a formula to distribute health care 0:01:07.920 --> 0:01:12.560 aid to states and which agency should oversee a stepped 0:01:12.600 --> 0:01:16.440 up testing program. According to people familiar with the discussions, 0:01:17.480 --> 0:01:20.840 the package would inject billions into the tapped out paycheck 0:01:20.880 --> 0:01:25.280 Protection program, which aims to help small businesses keep paying workers. 0:01:26.200 --> 0:01:29.840 The SBA program has already exhausted the three hundred and 0:01:29.840 --> 0:01:34.000 fifty billion dollars it was allotted. Just weeks ago. It 0:01:34.120 --> 0:01:38.280 also includes funding for hospitals, particularly in rural areas, and 0:01:38.360 --> 0:01:42.640 a testing program. Over the weekend, a handful of small 0:01:42.680 --> 0:01:46.880 protests against lockdown measures were met with support by President 0:01:46.920 --> 0:01:51.160 Donald Trump. That support goes against the guidance of his 0:01:51.280 --> 0:01:57.000 own administration's experts. Dr Anthony Fauci, the country's top infectious 0:01:57.040 --> 0:02:01.400 disease expert, said today that reopening WHO soon would damage 0:02:01.520 --> 0:02:04.880 the economy in the long run, not just public health. 0:02:05.880 --> 0:02:09.600 Faucia was asked on ABC's Good Morning America to respond 0:02:09.639 --> 0:02:13.639 to protesters who resisted stay at home orders with chants 0:02:14.080 --> 0:02:19.920 of fire. Fauci, Clearly, this is something that is hurting 0:02:20.400 --> 0:02:23.640 from the standpoint of economics, from the standpoint of things 0:02:23.639 --> 0:02:26.720 that have nothing to do with the virus. But unless 0:02:26.760 --> 0:02:31.200 we get the virus under control, the real recovery economically 0:02:31.320 --> 0:02:34.040 is not gonna happen. So what you do, if you 0:02:34.200 --> 0:02:37.040 jump the gun and go into a situation where you 0:02:37.080 --> 0:02:40.600 have a big speed spike, you're gonna set yourself back. 0:02:41.360 --> 0:02:46.400 It's gonna backfire. That's the problem. In Germany, which has 0:02:46.440 --> 0:02:49.920 been more successful than the US at limiting the outbreak spread, 0:02:50.639 --> 0:02:54.679 Chancellor Angela Merkel also warned that the country shouldn't move 0:02:54.680 --> 0:02:58.840 too quickly to ease up on social distancing measures. The 0:02:58.919 --> 0:03:02.000 Chancellor said that raises the risk of ending up with 0:03:02.040 --> 0:03:07.880 an even stricter national lockdown. In remarks on Monday, she 0:03:07.960 --> 0:03:10.799 said the country has made progress but not yet reached 0:03:10.840 --> 0:03:14.960 its target. Cases in Germany rose Monday by the smallest 0:03:15.000 --> 0:03:25.079 amount this month, and now for today's main story. Before 0:03:25.200 --> 0:03:28.920 COVID nineteen started spreading around the US, the country was 0:03:28.960 --> 0:03:33.639 already attempting to deal with another health crisis, opioid dependency. 0:03:34.920 --> 0:03:39.480 Although opioid treatment programs are considered essential public facilities and 0:03:39.600 --> 0:03:43.240 are allowed to stay open during statewide stay at home orders, 0:03:44.040 --> 0:03:48.520 experts are worried the coronavirus could exacerbate the opioid epidemic, 0:03:49.080 --> 0:03:54.760 possibly leading to more overdoses. Producer Jordan Gospure looked into 0:03:54.760 --> 0:03:59.600 how clinics and federal regulations are adapting to meet the 0:03:59.680 --> 0:04:05.880 knee of patients. For some patients with opioid use disorder, 0:04:06.320 --> 0:04:09.840 getting their daily dose of methadone, the prescription drug typically 0:04:09.920 --> 0:04:12.960 used to treat opioid dependency, is an essential part of 0:04:13.000 --> 0:04:16.920 their lives, but now standing in line or being in 0:04:16.960 --> 0:04:20.560 a crowded waiting room at an outpatient treatment program could 0:04:20.600 --> 0:04:25.400 increase the risk for COVID nineteen infection. Dr Sue Kim 0:04:25.480 --> 0:04:28.919 is the medical director of the Harm Reduction Coalition and 0:04:29.000 --> 0:04:33.479 an addiction medicine attending physician. We know that people who 0:04:33.600 --> 0:04:37.880 use drugs are often they could be at higher risk 0:04:37.960 --> 0:04:41.760 for acquiring this, or they might have conditions that predispose 0:04:41.839 --> 0:04:46.200 them to doing poorly if they do acquire covid um 0:04:46.240 --> 0:04:56.039 So it's it's a very difficult situation. Those with opioid 0:04:56.080 --> 0:04:58.560 use disorder are already more at risk of homelessness and 0:04:58.600 --> 0:05:02.800 incarceration than those the general population. Now they may be 0:05:02.880 --> 0:05:06.440 enabled to get necessary medications and treatments vital to the recovery. 0:05:07.480 --> 0:05:10.320 In the US, methodone can only be dispensed at highly 0:05:10.320 --> 0:05:14.200 regulated and monitored opioid treatment programs. There are nearly two 0:05:14.200 --> 0:05:17.080 thousand of these programs across the country that see thousands 0:05:17.080 --> 0:05:21.560 of patients. Many patients taking methodone or the prescription bupenorphine 0:05:21.600 --> 0:05:24.240 to treat their opioid use disorder aren't able to stay 0:05:24.279 --> 0:05:27.440 at home because of strict government regulations that limit the 0:05:27.480 --> 0:05:32.160 way these medications are prescribed and dispensed. Before the coronavirus pandemic, 0:05:32.400 --> 0:05:35.680 Some patients over time were able to take home a 0:05:35.760 --> 0:05:38.280 limited number of doses because they gained the trust of 0:05:38.320 --> 0:05:41.280 the clinic, but even the most trusted patient generally had 0:05:41.320 --> 0:05:43.360 to return to the clinic or pharmacy once a week 0:05:43.440 --> 0:05:47.840 for a supervised dose. The federal government temporarily relaxed restrictions 0:05:47.839 --> 0:05:49.760 in March for some patients to take home up to 0:05:49.800 --> 0:05:52.720 a month's worth of their daily methodone or bupanorphine doses, 0:05:53.160 --> 0:05:57.400 depending on their stability and treatment. Addiction advocates have along 0:05:57.480 --> 0:06:00.160 pushed for these changes, and research shows at making inti 0:06:00.160 --> 0:06:05.479 addiction medications more easily available cuts opioid overdoses in half. Still, 0:06:05.760 --> 0:06:09.039 even during a pandemic, Dr Kim says clinicians are leery 0:06:09.080 --> 0:06:12.120 about giving patients take hoome doses because they're afraid they'll 0:06:12.120 --> 0:06:17.120 be lost, stolen, sold early to an overdose. And these 0:06:17.160 --> 0:06:21.200 clinics are are each operating into you know, they might 0:06:21.279 --> 0:06:25.000 operate independently, but they are all overseen by particular state 0:06:25.040 --> 0:06:28.880 opioid treatment authority who dispenses the kind of the advice 0:06:28.920 --> 0:06:31.720 and the regulations. But it needs to trickle down to clinics, 0:06:31.720 --> 0:06:33.880 and clinics end up having to make a lot of 0:06:33.920 --> 0:06:41.800 decisions for their patients. It's incredibly complex. Opioid treatment facilities 0:06:41.839 --> 0:06:44.680 around the country have had to change the rehabilitation techniques 0:06:44.680 --> 0:06:48.200 in the face of the coronavirus pandemic. New patients can 0:06:48.240 --> 0:06:51.360 now be prescribed even orphine virtually or by phone, but 0:06:51.440 --> 0:06:54.520 for people recovering from opioid used disorder, the new guidelines 0:06:54.520 --> 0:06:58.320 have been inconsistent. There have been reports of some states 0:06:58.360 --> 0:07:01.200 requiring patients with take hoom do is to come into 0:07:01.200 --> 0:07:05.360 the clinic. Despite changes in federal guidelines. Other clinics are 0:07:05.360 --> 0:07:09.120 having problems tracking the medications substance of use them into 0:07:09.160 --> 0:07:12.119 Health services have finally issued some protocols in recent weeks. 0:07:12.160 --> 0:07:14.520 That's starting to make some difference in what towns and 0:07:14.560 --> 0:07:17.440 cities can do, but there's still a lot of confusion 0:07:17.520 --> 0:07:20.400 and a lot of fear. Even when a clinic is 0:07:20.560 --> 0:07:23.320 business as usual, those patients who pay cash for their 0:07:23.320 --> 0:07:26.800 medication are unable to afford more than their daily prescription. 0:07:27.480 --> 0:07:30.440 I recently spoke with Melissa Dunford, who started the Faces 0:07:30.440 --> 0:07:33.480 of Opioids Facebook group in sen for those who have 0:07:33.520 --> 0:07:36.840 been affected by the epidemic after a friend fatally overdosed 0:07:37.280 --> 0:07:39.280 she's heard stories from some of the members who have 0:07:39.360 --> 0:07:41.920 no recourse but to find the money or forego life 0:07:41.920 --> 0:07:45.680 saving treatment. What we're finding is one our cash patients 0:07:45.800 --> 0:07:47.960 are hosed or screwed over because they might not have 0:07:48.080 --> 0:07:50.440 money to pay for a thirty day supply and go 0:07:50.520 --> 0:07:53.680 home with it. So one woman was told, sorry, get 0:07:53.680 --> 0:07:55.480 the money, or you don't get your medicine and just 0:07:55.520 --> 0:07:58.480 set out the door. Experts warn that COVID nineteen will 0:07:58.520 --> 0:08:01.880 only worsen the opoid crisis. Workers at some opioid treatment 0:08:01.880 --> 0:08:05.560 facilities don't have enough face masks and gloves, so these 0:08:05.560 --> 0:08:10.080 programs are limiting their hours or shutting down completely. Online 0:08:10.080 --> 0:08:12.320 help groups are working to fill these gaps, but there's 0:08:12.320 --> 0:08:15.160 a risk that social isolation or an interruption to treatment 0:08:15.400 --> 0:08:17.640 may make it harder for some people to stay in recovery. 0:08:20.240 --> 0:08:24.080 Withdrawal sometimes mimics the symptoms of the coronavirus, so there's 0:08:24.080 --> 0:08:27.239 a fear that physicians evaluating patients with opioid use disorder 0:08:27.320 --> 0:08:30.680 will fail to identify cases of COVID nineteen. Staying at 0:08:30.720 --> 0:08:33.520 home may increase feelings of depression and anxiety, and patients 0:08:33.800 --> 0:08:36.720 who are at an increased risk of relapse and fatal overdose. 0:08:37.280 --> 0:08:39.719 If they live alone and overdose, no one will be 0:08:39.800 --> 0:08:42.400 there to administer no losin, the drug used to reverse 0:08:42.440 --> 0:08:47.600 opioid overdoses, Further complicating the problem, if black market drug 0:08:47.640 --> 0:08:50.720 supplies decrease, opioid dealers will be more likely to lace 0:08:50.800 --> 0:08:55.120 drugs with other dangerous substances like fentyl. Dr Kim says 0:08:55.120 --> 0:08:58.160 restrictions on movement may also prevent patients from buying drugs 0:08:58.160 --> 0:09:01.800 from the regular dealer, so out of desperation, will buy 0:09:01.880 --> 0:09:04.920 drugs from someone else. I've been concerned that a lot 0:09:04.920 --> 0:09:08.040 of my patients who were managing to get money for 0:09:08.120 --> 0:09:11.680 harrow and every day now don't have jobs. UM. So 0:09:11.840 --> 0:09:15.840 you know, everyone is UH in the addiction communities keenly 0:09:15.920 --> 0:09:19.040 aware of UM. Of how much we need to get 0:09:19.160 --> 0:09:21.920 these medications to people, and how life saving they are, 0:09:22.640 --> 0:09:26.680 and how we can need to be flexible and UM 0:09:26.720 --> 0:09:31.079 and accommodating so UM and give an orphan and method 0:09:31.080 --> 0:09:34.600 and are much safer, and we prefer people to beyond 0:09:34.600 --> 0:09:37.560 those treatments. Health providers in the US are working to 0:09:37.600 --> 0:09:40.520 make sure patients with opioid use disorder still have access 0:09:40.559 --> 0:09:44.640 to treatment, even from a distance. As the coronavirus sweeps 0:09:44.640 --> 0:09:47.600 across the country, closing businesses and forcing many people to 0:09:47.600 --> 0:09:50.920 stay at home. Telehealth treatments are more important than ever. 0:09:51.760 --> 0:09:55.840 Social isolation and an overburdened health system could undermine years 0:09:55.840 --> 0:09:58.720 of progress officials have made in addressing the opioid crisis. 0:09:59.400 --> 0:10:01.720 There are fear is that even once the coronavirus is over, 0:10:02.280 --> 0:10:04.679 it will continue to have profound effects on people with 0:10:04.720 --> 0:10:22.040 opioid use disorder. That was producer Jordan Gaspore. That's our 0:10:22.080 --> 0:10:25.120 show for today. For more on the outbreak from one 0:10:25.520 --> 0:10:29.439 and twenty bureaus around the world, visit Bloomberg dot com, 0:10:29.480 --> 0:10:34.679 slash coronavirus and one Small favor. If you appreciate the show, 0:10:35.000 --> 0:10:37.680 please leave us a review and a rating on Apple 0:10:37.720 --> 0:10:41.240 Podcasts or Spotify. It's the best way to help more 0:10:41.320 --> 0:10:46.199 listeners find our global reporting. The Prognosis Daily edition is 0:10:46.240 --> 0:10:49.760 hosted by Me Laura Carlson. The show was produced by 0:10:49.800 --> 0:10:55.480 Me Topher Foreheads, Jordan Gaspore, and Magnus Hendrickson. Today's main 0:10:55.559 --> 0:10:59.959 story was reported by Jordan gas Poore. Original music by 0:11:00.120 --> 0:11:04.400 Leo Sidran. Our editors are Francesco Levi and Rick Shine. 0:11:05.080 --> 0:11:09.280 Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.