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Budget cuts, relapses, and recovery: How the pandemic could perpetuate the opioid crisis

Millions cut from substance use disorder treatment
Pandemic perpetuates opioid crisis
Posted at 6:00 AM, Jul 27, 2020
and last updated 2020-07-29 19:17:38-04

SOUTHERN COLORADO — The coronavirus pandemic has caused job loss, promoted isolation, and created a lot of stress overall, adding to a mounting mental health struggle in the country. Addiction experts say it has the potential to increase the strain on those with substance use disorders as well.

News5 took an in-depth look at how coronavirus has impacted people in recovery, how it has affected funding for treatment, and even positive changes that may be a result of the pandemic.

Relapses during the pandemic

Addict to Athlete is a support group for people who live with substance use disorders. It is open to anyone who would like to participate, but a number of their clients are there as a way to help stay clean.

The coronavirus caused gyms to close for a few months. "The gym being closed really impacted our clients, because they felt like there was no safe haven for them to come. It got them out of their normal routine," said Sheena Archuleta, the co-founder and executive director of Addict to Athlete.

Archuleta said they tried to keep clients motivated through virtual challenges during the closure. "Zoom is great to a certain extent, but people like our clientele need that interaction... COVID-19 stopped a lot of things, but addiction was not one of them," said Archuleta.

Since the gym has reopened, there are still some clients who have not returned. "We have had some clients relapse. Some have come back, some are still actively using," said Archuleta.

Those with the gym said it creates a camaraderie that's hard to replace. Fernanda Sharpe is a gym manager at Addict to Athlete, and she wishes the clients who relapsed had come to her first. "I can't imagine someone that's going through addiction and all those hard thoughts you have to think by yourself. It's a tough thing to do... I still love them, you know, that's all I can say," said Sharpe.

Budget cuts to substance use treatment programs

The Southern Colorado Harm Reduction Association in Pueblo offers a variety of services to try and keep people safe while they are actively living with addiction. "We are here for the before and the after and the during," said Judy Solano, the executive director of the Southern Colorado Harm Reduction Association.

Solano said they have had to limit their hours since the pandemic and are now only open for two hours on Saturday afternoons. However, on average, Solano said they see approximately two-thirds of the population they saw before coronavirus.

Solano said the makeup of drugs being used aligns with what was noticed before COVID-19: methamphetamine, heroin, and pills. "Just goes to show that there has been no changes in people's activity and their ability to obtain the substances that they're using," said Solano.

El Paso County Coroner Dr. Leon Kelly said the number of drug-related deaths has remained steady over the past few years. However, he is concerned about the increasing numbers being seen in fentanyl-related deaths.

In 2019, there were 21 deaths associated with fentanyl in El Paso County. Already in 2020, as of July 23, there have been 20 fentanyl related deaths. Kelly said we are on track to double the number of deaths in that category. "The illicit drug manufacturers, the drug dealers, have figured out a way to stamp that fentanyl into tablets and pills that can be distributed much more readily, often kind of masked as other medications like oxycodone," Kelly said.

Meanwhile, the Pueblo County Coroner reported 11 accidental fentanyl-related deaths in 2019, and three so far this year.

Despite the drug usage in Colorado, millions of dollars were cut from state funding of substance use disorder treatment this year. Division Director for Community Behavioral Health Camille Harding explained how those cuts will impact the state and what's being done to make up for them.

Community Behavioral Health falls under the umbrella of the Office of Behavioral Health. Harding said there was around $20 million cut to the community division over the course of the last session. The most significant cuts were generally on new programs that had not been fully enacted or stood up yet.

The Office of Behavioral Health's budget has seen decreases in state general fund dollars from last fiscal year, which resulted in a reduction in state funding for substance use disorder treatment.

FY 18-19FY 19-20FY 20-21
Total State Appropriations for Community Behavioral Health$187,864,400$213,888,521$197,477,085
State Appropriations for SUD Treatment$70,523,173$83,160,242$71,669,210
Without COVID's impact on the budget, OBH's Community Behavioral Health programs would have received more than $217 million through the state budget process. Not only would the division have avoided the $20 million of budget cuts in state appropriations necessary to balance the budget, some of the bills considered in the 2020 session, such as those from the Opioid and Other Substance Use Disorders Interim Committee, would have brought more new money to OBH. Those bills were amended to remove funding because of COVID's impact on the economy. The funding cut to Community Behavioral Health will be largely mitigated in FY 21 by federal CARES Act funds and other federal grants to sustain services at pre-COVID levels.
Lindsay Sandoval, CDHS
Community Behavioral Health Budget
A graph shows the budgets for both FY 2019-2020, and FY 2020-2021.

These gaps in funding will be filled using federal money. The Office of Behavioral Health expects to get $20.8 million per year for the next two years under the upcoming State Opioid Response Grant. "With this additional $20 million dollar grant, they've expanded it to be used for stimulant use disorder as well, so that includes methamphetamines which we think is pretty important," said Harding.

The funding amount from the Substance Abuse Prevention Block Grant has also increased, and they are receiving around $13 million from the CARES Act. A little more than $4 million of that CARES money is allocated for substance use disorder treatment specifically and has to be spent by the end of the year. CARES Act funding can only be used for COVID-19 related expenses.

A new Medicaid residential treatment benefit is also expected to go into effect in 2021, which would shift substance use disorder treatment funding to the Colorado Department of Health Care Policy and Financing. This would free up the Office of Behavioral Health's dollars to have more resources.

Harding said there will be a bit of a reduction to medication-assisted treatment in jails and that Colorado Crisis Services saw some cuts largely around their marketing campaign. There were also decreases in the funding for transportation pilots, which essentially pays for infrastructure to ensure patients have the transportation they need. "Looking down the road, we need to continue to keep an eye out for how we're expanding services in rural communities," said Harding.

Harding also said their office is in the process of completing a statewide needs assessment around mental health and substance use disorder treatment. That is scheduled to be released to the public near the end of July.

Some legislation regarding substance use disorder treatment did make it through the session this year. Bri Buentello is a member of the Colorado House of Representatives, representing District 47, and is particularly proud of two measures related to substance use treatment she sponsored that were passed.

SB20-007 streamlines the addiction identification process and requires insurance companies to provide coverage for the treatment of substance use disorders falling under certain criteria. SB20-028 was also passed, and Buentello is most proud of the way it allocates behavioral health funds specifically for treating pregnant women who struggle with addiction. "My big concern was making insurance companies pay for a health crisis that frankly, they started... People are isolating, and that is especially difficult for people who struggle with addiction... Unfortunately, I think we will see a very drastic spike in opioid addiction," said Buentello.

The Colorado Drug Overdose Dashboard provides statewide data for fatal and non-fatal drug overdose events. It can be broken down by county as well.

José Esquibel is the associate director of the Colorado Consortium for Prescription Drug Abuse Prevention. He said they have been getting anecdotal information from across the state on overdose deaths throughout the pandemic. "I've been asking our data experts, what are we seeing right now? And it really is too early to tell... Such as in the northwest, we're hearing concerns where people are reporting that there's an increase in overdose deaths, but we're not yet able to pull the data together to really substantiate what we're hearing... We're seeing some preliminary data in other parts of the country that is suggesting that it's having a greater impact on the opioid crisis, and addiction just in general," said Esquibel.

Esquibel said a huge issue in Colorado is accessing treatment. So, the consortium has been funding a medication-assisted treatment program in rural areas, meaning eight organizations are providing treatment in around 40 different clinics.

However, Esquibel said he is anticipating a fallout in substance use as a result of the pandemic. "When it comes to addiction, issues such as isolation, the stress of losing a job... We just know that psychologically this is going to put people at greater risk, whether that means they're going to fall into addiction and abuse, or whether that means they were in recovery and now become overwhelmed by the social stress or the psychological-emotional stress that they begin to relapse," said Esquibel.

Esquibel did also point to a report that shows the financial impact of the opioid crisis on Colorado's economy before coronavirus sparked high unemployment rates. Esquibel's post summarizes an analysis from the American Action Forum, which states that Colorado lost $21 billion in real economic output from 1999 to 2015 because of the number of potential laborers not in the workforce. That's because opioids are believed to have pulled those thousands of workers from the economy.

Recovery is possible

News5 also met with the Program Director at Sandstone Care's detox location in Colorado Springs. Danielle De Boer said they are doing everything they can to continue their care as normally as possible. They offer both in-person and virtual services for their clients.

She did say the pandemic has definitely affected her clients. "Many of them that thought they were managing their drinking or their using, the pandemic brought light to all the problems. Now, they couldn't hide them as well as they had been before," said De Boer.

She called the pandemic a catalyst, bringing light to issues that already existed. "There's actually a lot of positive things that I see coming out of this, that are potentially increased support for mental health as a whole, and for addiction specifically... Increased acceptance that these life stresses are very real," said De Boer.

One of the people De Boer has worked with in the past is Sparkle Lindsay. You may know Lindsay's brother, Denver Bronco Phillip Lindsay, but she's been in her own arena of sorts for a while now.

Lindsay has been clean for around 14 months and is now a peer support specialist at Springs Recovery Connection. "The more I gave back, and the more I was helping people find their journey, and find their success, it just gave me this adrenaline... The main thing is the hope because you see people's faces light up when they know somebody's with them," said Lindsay.

Springs Recovery Connection said their call volume spiked by around a third when the pandemic first started.

Lindsay said everyone could learn something from a person in recovery. "We live day-by-day, and we have to wait and wait and wait to see what's to come... We can only control what we can control, and things are just going to be what they're going to be," said Lindsay.

She also said, if a relapse does occur, that there ought to be self-examination afterward. "The big part of relapse is, have you researched it? Do you know why you drink? Can you ask yourself those questions?" said Lindsay.

Springs Recovery Connection is always looking for volunteers to help. CLICK HERE to learn more about how you can help.

If you or anyone you know is struggling and needs some help, call Colorado Crisis Services at 1-844-493-8255 or text "TALK" to 38255.