Health experts warn that people who use drugs are particularly vulnerable to COVID-19, the deadly disease caused by the coronavirus.
Not only do their potentially compromised lungs and respiratory systems mean they could face a higher risk from the infection, stay-at-home orders have made it more likely that they will use drugs at home alone — leading to greater risk of overdose. This has advocates and clinics looking for different ways to help their clients while still following social distancing rules.
Jordan, who describes herself as a daily heroin user, wakes up every other morning and makes the trek to a nearby methadone clinic for treatment.
Though the New Orleans clinic is close to her apartment, Jordan — who asked to use a pseudonym for this story — still worries about coronavirus contact.
A host of potential exposures exist between her front door and her scheduled dose, which reduces opioid craving and withdrawal: The buttons, steering wheel and door handles of the car she borrows; the gas pump when she refills the tank; the communal pen she uses to black out her name on the prescription bottle before she throws it away, per clinic policy.
In the first few weeks of the pandemic, Jordan said the clinic was limiting occupants to 10 people at a time — but that meant the line outside stretched for blocks while people crowded together to wait for their turn.
“Everyone was getting very nervous and scared, wanting to be as close to the door as possible,” she said. “It didn’t feel super safe.”
She said throughout the month the line thinned as "stable" patients got approved for take-home doses that could be re-upped at longer intervals than a couple of days.
If Jordan stops going to the clinic, she could experience painful withdrawals, so cutting her dosage short is not an option. This scares her, in part because she knows someone in her position could be particularly vulnerable to the disease.
People who use drugs potentially face a higher risk if they contract COVID-19, according to the National Institutes of Health. The disease attacks the lungs, which threatens people who smoke tobacco or marijuana. And the dangers opioids and methamphetamines pose to overall respiratory health might make it harder to recover from COVID-19
Janzleen Laughinghouse, interim executive director of Capital Area Human Services, said she and her colleagues in Baton Rouge have been working to address the needs of people across a spectrum of drug use during this uncertain time.
"They just want to be healthy and safe, and get on the other side of this like everyone else," she said.
Through social media and tele-health technologies, her clients have been able to congregate for group therapy or speak to an individual counselor in private. Laughinghouse said that they have seen a high compliance rate among clients, who no longer have to worry about transportation or childcare needs to receive the care they need.
Clients also continue to receive Vivitrol, which is an injection drug that blocks the opioid receptors in the brain, and Suboxone, which is a partial opiate agonist used to treat addiction — administered by a skeleton crew of staff on site at their Government Street location.
"We don’t want to abandon the community," Laughinghouse said. "Their needs are not going to decrease, they’re going to increase."
Christopher Sunseri, an adult mental health manager with the Center for Adult Behavioral Health, speculated people may turn to substance use to handle the anxieties of the pandemic.
Sunseri works primarily in mental health services, but said that some clients they see have "co-occurring disorders," such as a substance use disorder alongside depression and anxiety. His team now sees clients who need medication to treat mood disorders in tents outside CAHS.
"We're still standing with the community," Laughinghouse said. "We don’t want people to think we shuttered our doors."
In the meantime, advocates are working to keep people who use drugs safe amid the pandemic, whether they use recreationally or their use has been diagnosed as disordered.
Logan Kinamore, founder of No Overdose Baton Rouge and a former injection drug user, said advocates have been doing their best to provide materials including syringes, Narcan (which prevents overdoses) and sterile smoking devices while working to get people enough supplies to last for longer stretches of time so they don't have to expose themselves to potential close contact.
"What we attempt to do is provide people with the tools, resources and knowledge that reduces as much harm to them as possible," Kinamore said.
There are also concerns about people overdosing while using alone. According to data from Baton Rouge Emergency Medical Services, overdose calls have increased in the last two months compared to data from the same time frame in 2019. And 2019 was reported as the worst year for overdose deaths on record for the parish.
Advocates fear that, with the virus causing mass self-isolation, people will be more likely to use drugs alone, when no one is there to administer Narcan or call an ambulance. So Kinamore suggests scheduling Zoom calls or check-in texts while using to keep people safe.
"People who use drugs are at significant risk for contracting COVID-19 for many reasons," Kinamore said. "They deserve our attention, compassion and understanding as much as any other member of the community."
As for Jordan, she feels lucky she began her methadone treatment before the pandemic really hit. She decided to try methadone because she was having trouble controlling “all aspects of [her] life.”
“When working enough to get the amount of drugs that I needed was taking up all of my time...I felt stuck,” she said. “For me, getting on methadone was regaining some control of my life and having more options. That feels good.”
This past week, Jordan was finally approved for a two-week take home dose; she's relieved.