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Castan: The road less traveled of addiction & recovery in Scottsdale


Back in the early spring of 2020 (how long ago does that seem now?), the coronavirus pandemic arrived on the shores of the U.S., bringing with it a plethora of state and county lockdowns, and the enforced isolation of vulnerable communities, such as the old, the poor, the addicted, and the mentally ill.

All across the nation, the sound of business doors clanging shut for the foreseeable future resonated throughout the near-deserted streets and shopping malls. Everything was corona, corona, corona… now the only public health emergency in town.

Everything else? Well, that just fell off the newspapers’ front pages, and pretty much fell by the wayside of the governmental and public consciousness.

No, it didn’t seem to matter that we were already fighting an epidemic — the national opioid crisis, even though a number of addiction industry expert voices were predicting a profound knock-on effect — a distinctly negative one, for sure — for those with substance use disorders and mental health disorders, such as clinical depression, bipolar and PTSD.
Their warning was a simple one — isolation kills.

Isolation’s major effects on mental health

One of the loudest voices came from Dr. Elinore McCance-Katz, assistant secretary with the Substance Abuse and Mental Health Services Administration, who warned earlier in the year, “When you restrict activities, when you isolate people, when people lose their employment, this has major effects on mental health. For people who have substance problems, it can make them worse. For people who don’t have substance problems, it may initiate the use of substances.”

Furthermore, Dr. McCance-Katz highlighted her own deep concerns regarding the immediate operational future of addiction treatment centers: “Our mental health system, our substance-use-disorder treatment system has been virtually shut down. We often don’t have facilities that can do 6-foot social distancing,” blaming “a complete lack of concern or any ability of government officials to contemplate any other health risk except for COVID-19.”

COVID-19: The only health emergency in town

As of the end of this year, the New York Times had reported that U.S. COVID-19 case numbers were “as high as they have ever been.” The total number of infections surpassed 19 million on Saturday (Boxing Day), meaning at least 1 in 17 people have contracted the virus over the course of the pandemic. The death toll now stands at more than 332,000 people, which equates to 1 in every 1,000. The future, even with the vaccine rollout, doesn’t look too rosy either.

Now, the “profound knock-on effect” previously voiced by experts has clearly been realized — brought about by the COVID-19 lockdowns, addiction treatment centers having to shut their business doors, too, church halls and other community centers no longer considered appropriate for AA and NA meetings, limited access to medical assistance, widespread unemployment, and so on.

Forced to go down a road less traveled in terms of traditional treatment, the addiction industry has sadly witnessed a terrible year in the fight against the opioid crisis, with growing pockets of record numbers of drug overdose fatalities now dotted across many parts of the nation, including in Arizona, meaning certain areas have never seen so many overdose fatalities before in the history of the epidemic.

So we know many of the contributing factors to this rise in overdose deaths in Arizona and elsewhere — the isolation, a decline in mental health, increased anxiety and depression, limited access to addiction treatment, as well as individual and group support moving online.

However, are there other factors at work here, not perceived by those voicing their warnings back in springtime, and only just being seen and understood now? Sadly, yes, and it all revolves around how drug addicts get their illicit substances of choice.

Synthetic opioids now being detected in many illicit drugs

At the beginning of 2019, fentanyl, a highly potent synthetic opioid, started being detected in other drugs, such as heroin, meth, cocaine, and ecstasy.

Those drugs had begun killing more and more unsuspecting drug users in cities like Los Angeles, San Francisco, Seattle, and our own Phoenix.

Even before the pandemic, drug overdose deaths were trending upwards — this year, they have skyrocketed. In April 2020 (the latest month of official government reporting), there were nearly 78,000 drug overdose deaths, based on preliminary federal data — that’s a 13% increase from the same time last year.

2020 looks likely to be the worst year for drug overdose deaths ever.

A Stanford University epidemiologist recently observed that fentanyl is now being detected in everything: “You think you’re using heroin, or you think you’re using ecstasy or Xanax or what looks like an OxyContin pill, but it’s actually fentanyl. The spike in fentanyl deaths in the West contributed to a record number of fatal overdoses last year.”

And, sadly, it doesn’t stop with just fentanyl.

In Phoenix’s metropolitan area, as well as other major city areas, there has been a significant increase in carfentanil use. Carfentanil is an opioid drug 10,000 times more potent than morphine, and, like fentanyl, it is manufactured synthetically.

Carfentanil poses a major threat on separate fronts — for the unsuspecting drug addict using a product with the powerful opioid cut into the substance, and for the first responders trying to save the lives of those users who do overdose, as they themselves can contract a fatal dose through simply touching or inhaling the carfentanil.

As little as 7 grains of the carfentanil opioid is enough for that to happen.

The drug cartels & synthetic opioids

So why is there now a preference for these synthetic opioids to be cut into other drugs, eg. other opioids, including heroin, methamphetamine, cocaine, and ecstasy? The answer to that, unfortunately, does not lie within the borders of the U.S.

Mexican drug cartels are now pushing products that are potentially lethal to the consumer. Killing your client base doesn’t look anything like good business sense until you see facts: It’s much cheaper to manufacture, and so it’s much more profitable.

In fact, their “newer products,” with the addition of these synthetic opioids, are more profitable than the heroin and cocaine they previously made their endless millions of dollars from.

Simply put, money. It always comes down to the money — even with lives at stake.

Furthermore, states like Arizona are well-located geographically for the cartels to route their products through. Therefore, with drug dealers in Arizona’s metropolitan areas, like Scottsdale, having their normal drug supply chains affected by the coronavirus lockdowns (another knock-on effect of the pandemic), it has made sourcing their own supply of drugs to sell far easier.

The status of addiction treatment in Arizona

Addiction treatment has always been difficult to access in the US., well before we ever heard of a possible opioid epidemic. According to federal data, only 1 in 10 people with a substance use disorder get the specialized addiction treatment they need.

Most of this huge shortfall lies in a lack of more local facilities, high costs, and health insurance issues.

Additionally, even though there is rigid, researched direction on evidence-based therapies, not all centers adopt them, and, of course, there are those that are simply fraudulent.

The coronavirus pandemic prompted government and state officials to relax regulations in several ways. On a federal level, they permitted:

  • Doctors to prescribe buprenorphine, an evidence-based medication for opioid addiction, without requiring an in-person evaluation (video or audio calls were temporarily considered sufficient)
  • Easier to prescribe the medication across state lines
  • Eased rules for take-home doses of methadone, another proven opioid addiction medication (as opposed to an in-person clinic)
  • Additionally, state and federal officials made it possible for public health insurance programs, like Medicare and Medicaid, to pay for telemedicine addiction treatment services
  • Ability to deliver methadone to patients rather than requiring they pick it up in person

For the addiction treatment centers in Arizona, like our own Springboard Recovery in Scottsdale, clear advances have been made, too:

  • Operational COVID-19 protocols and regulations in place for patient safety
  • Utilization of “telemedicine” technology
  • Patients accustomizing to accessing their treatment, care and support online, and
  • The wider use of methadone and other opioid replacement drugs, as regulations have been relaxed.

However, as Dr. Kelly J. Clark, the former president of American Society for Addiction Medicine and vice chair of the group’s COVID-19 task force, recently stated, “While our attention has gone to COVID, and rightly so, our overdose deaths have skyrocketed. We have to keep overdose deaths on the map.”

It would appear the rise in fatal drug overdoses across metropolitan Phoenix, and the rest of Arizona, will, like the coronavirus, take a long, long time to bring firmly back under control.

Editor’s Note: Robert Castan is CEO of SpringBoard Recovery addiction treatment center in Scottsdale.