HARRISON -- Bradley Cambell didn't finish his stay at Humbled Hearts' Haven House, a sober living home for men, earlier this year. It wasn't that he didn't stay clean but because covid-19 caused the nonprofit to temporarily close.
Months went by, Cambell stepped out of his routine and used again after six and a half months sober, he said. But when the nonprofit opened again in October, he knew he needed to return and finish the work he'd started to stay sober.
"I was here again as soon as the houses were back open. God has me here for a reason," Cambell said.
He doesn't blame the pandemic, though it was the reason he was thrown off his schedule and from his daily in-person support network at Humbled Hearts.
"I lost sight of my priorities. I wasn't staying in classes, in a regular routine...Idle hands for eight months," he said. "I can't blame nobody but myself. I couldn't be more grateful to each and every person here in the program."
Humbled Hearts is one of many sober living homes and recovery outreach groups in the state that had to shut down at some point this year, are still shuttered or open at limited capacity, said program Director Trisha Earnhart and officials at other programs.
Arkansas has 33 licensed residential substance abuse centers. Five are Arkansas Community Correction programs. Nonprofits such as Humbled Hearts are not classified as Alcohol and Other Drug Abuse Treatment Programs and are not licensed by the state, so the state does not have an official tally.
Even before the pandemic, Earnhart said Arkansas' need for substance abuse treatment programs was great; covid has only made it worse.
"Going into a sober living home after leaving an addiction treatment center can oftentimes make the difference between sobriety and relapse," said Earnhart, who graduated herself from recovery in 2016 before founding Humbled Hearts. "People are relapsing left and right not having that everyday support. We've lost people."
Over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020. That's the highest number of overdose deaths ever recorded in a year-long period, according to recent provisional data from the U.S. Centers for Disease Control and Prevention.
While overdose deaths were already increasing, the latest numbers suggest an acceleration of overdoses during the pandemic, according to a Dec. 18 CDC news release.
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"The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard," said CDC Director Robert Redfield. "As we continue the fight to end this pandemic, it's important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences."
BEFORE AND AFTER
Although the numbers continue to improve, Arkansas has one of the most severe opioid problems in the U.S., said Kevin O'Dwyer, Arkansas State Medical Board general counsel.
Arkansas has the second-highest opioid prescribing rate in the nation, according to Arkansas Take Back, an educational program under the state Department of Human Services.
In 2018, 67,367 (20.7 per 100,000) people in the U.S. died from drug overdose, a 4.6% decrease from 2017 (21.7 per 100,000). Opioids -- mainly synthetic opioids other than methadone -- are currently the main drivers of drug overdose deaths, according to the CDC's latest published data.
Arkansas had 444 drug overdose deaths -- a rate of 15.7 per 100,000 -- in 2018, placing it squarely in the middle in terms of states' rates, according to CDC statistics.
Prescriptions for highly addictive opioids have decreased about 29% from 2017 to 2019 for Arkansans with Medicaid and private insurance coverage, according to a 2020 analysis by the Arkansas Center for Health Improvement. The state also is seeing an increase in prescriptions for the anti-overdose drug naloxone for those who were prescribed high-dose opioids during that time, the analysis showed.
In addition to prescription and naloxone numbers, many who work to address drug abuse in the state said treatment and peer-to-peer recovery programs play a big role.
Jimmy McGill, Arkansas Take Back peer recovery program manager, said the state is a national leader when it comes to recovery efforts and is continuing to build upon its resources, such as recently launching four new jail programs and hospital programs.
McGill said that covid-19 caused a spike in relapse rates in Arkansas, which has anywhere between 30,000 to 40,000 people in long-term substance abuse recovery. Many of the safety nets people rely on to help them stay sober – group meetings, gyms and churches, for example – shut down, he said.
"In the very first time in everyone's recovery, the unthinkable happened: Everything was taken away from us in a blink of an eye... All of a sudden, we're seeing people with long-term clean time using. Somebody who's been clean 20 years is drunk and catching DUIs. It's insane," said McGill, whose words were echoed by many others in the field.
Drug overdoses appear to be slightly down from 2019 (12.03 to 11.96 per 100,000 in 2020), according to Dec. 11 Health Department data. However, naloxone deployments rose from 192 in 2019 to 379 in 2020.
"We saw a triple rise in naloxone administrations. What we saw that was very unique is that a lot of people who survived those overdoses ended up in the suicide numbers later on. We believe covid played a massive part in that," McGill said. "Covid stopped a lot of stuff, but it didn't stop addiction. The dope house is still jumping. Where everyone put safety protocols, addiction capitalized, mental health crisis capitalized. Recovery was forced to step up."
The National Suicide Prevention Lifeline and the Disaster Distress Helpline both saw notable increases in call volume this year compared with 2019, according to the U.S. Department of Health and Human Services.
RECOVERY IN A PANDEMIC
In early spring, many treatment and outreach centers – if not shuttering entirely – began admitting only those who had just gone through medical detox or could prove they had been quarantining properly.
Riley Gambill with Recovery Centers of Arkansas said he didn't agree with the decision to limit admittance. Taking only people from detox excluded several affected populations, including those addicted to opioids and meth with no other way to enter treatment. But it seemed like the only way to ensure clients didn't have the virus before adequate testing was available.
"That was a big constraint when covid first started," Gambill said. "Our staff definitely see people struggling. We've had tough cases recently."
Recovery Centers of Arkansas is one of eight Arkansas Department of Human Services-funded contractors and serves five central area counties. It recently acquired a second sober living residence for a total of 36 men's beds and 16 women's beds. Gambill said the centers have had to reduce their bed capacity by half. Meanwhile, they've seen a 20 percent increase in new applications for their services.
"We have less capacity and more people interested than ever," he said.
Doctor appointments, counselor visits and even peer meetings have transitioned from in-person to online.
Arkansas Take Back also launched a recovery social media show that has been airing Wednesdays on news stations as well, McGill said. It has continued in-person outreach where possible, McGill said.
Gambill and others said online video services come with positives and negatives. The recover center's conversion from rehab to outpatient treatment has doubled, and meeting numbers have jumped up 3.5 times, Gambill said.
Some clients have had trouble getting over the technical hurdles while others may lack dependable internet or phone access, according to several service providers. For those who are able to connect, it has made meetings more convenient though less social and authentic, some said.
Jeannie, 59, drives an hour from her home to the Center for Addiction Services and Treatment at the University of Arkansas for Medical Sciences for drug screenings and check-ins. She did same for peer meetings, as well. She has had to go without seeing many family members, including her grandchildren, when they tested positive for the virus and worries about catching it or giving it unknowingly when going to appointments.
"When you've been at it two years, you don't want anything get in the way of that. But covid puts a lot of fear in my mind," said Jeannie, who did not want her last name used over privacy concerns.
Some clients worry about catching covid at the UAMS clinic because they associate it with the hospital and sick patients. The clinic has no interaction with admitted covid patients, does its own screening and is one of the safest places someone can be, program Director Michael J. Mancino said.
He said the clinic's staff has been surprised by how many patients are able to access online options. They have also brought people to the clinic and put them in rooms for Zoom meetings to limit interaction.
Worried about the virus, Jeannie attends peer groups online through UAMS. She misses seeing everyone in person and giving a hug when needed. However, Jeannie said she may still attend online occasionally after in-person meetings start up again if the weather is bad or she doesn't have time for the commute. Routine is a big thing, she said.
"There are people that you can touch base with and Arkansas groups you can find online. So don't isolate yourself," she said. "On these groups, people exchange numbers. People will be more than happy to do it as they have been for me.
"Recovery has changed my world and my family's world. Everyone around me is proud of me, and I know what I was going through. I was alive but I wasn't living. Ask for help. It will be the best thing you ever do."
Online options will stick around if not increase post-pandemic, according to service providers.
"It was on DHS radar before, but covid forced us to look at how important telehealth was," said Patricia Gann, deputy director at Arkansas Department of Human Services Mental Health and Addiction Services.
Even as sober-living residents take care and use covid testing, many applicants may find themselves on a six-month waiting list, like those at Humbled Hearts.
"We need the room," said Jim Creager, Humbled Hearts men's director. "People are dying, because they can't get in. We can't save them all, but what's the price of one?"
FUNDING, THE FUTURE
The Department of Human Services has worked to expand access to treatment for substance abuse issues both through its Medicaid program and through grant-funded programs, spokeswoman Marci Manley said.
"For example, as part of our Outpatient Behavioral Health Treatment transformation, all Medicaid-eligible clients have access to an array of outpatient-based substance use services. We've also worked to expand the availability of Medication Assisted Treatment and have significantly grown that provider base across the state," Manley said. "DHS also contracts with 7 providers across the state to offer substance use treatment for those who may not have another payer source."
Mancino said he sees patients who pay with cash because they don't have insurance, have lost jobs or can no longer afford treatment.
"We've tried to work with people, to give them scholarships, but that's not a sustainable model," he said. "Rent's still due and there's groceries to buy. The thing that gets dropped is substance use disorder treatment."
Programs that don't meet the level of care that requires a license or allows them to benefit from government funding are financially struggling to stay open.
Vickie Poulson opened Jeremiah Recovery House in 2013. The group now runs a two-year women's program in Green Forest, housing about four to six women at a time. It provides connections to resources for physical, mental, legal, financial, educational, employment and life skills, Poulson said.
"Our fundraising abilities were affected greatly with big losses in our major fundraisers all due to covid restrictions. We have not been able to introduce the women to as many opportunities due to social gathering restrictions," Paulson said.
Earnhart said Humbled Hearts has faced the same challenges, and she is concerned about the future if funding doesn't pick up. The organization recently added more men's rooms for a total of five women's rooms and nine men's rooms. She estimates the faith-based nonprofit has helped around 500 people in their recoveries.
Poulson said she could easily open two more houses, provided she had the resources.
"The need is far more than most people know," she said. "I am proud to say Arkansas is starting to address this need but we need help. Financial help, volunteer help, mentor help, teacher help, dental help, medical help, mental health help, legal help, and resources for housing, clothing and food."
Several residents described Humbled Hearts and their sober living experiences as a lifeline. For Cambell, it's meant being able to have a relationship with his children again, he said.
"I have a very good relationship with them now. God is the God of restoration," Cambell said. "Thanks to Trisha, and God's grace and mercy, I was able to come back here."
Experts do not know yet if of a higher percent of people who use drugs or have substance use disorder are infected than for those who don’t use drugs.
Some underlying medical conditions such as chronic lung disease and serious heart conditions seem to increase risk of severe illness from COVID-19. Drug use can have serious effects on the body, including: The use of opioids can cause slow and ineffective breathing, which can lead to decreased oxygen in the blood, brain damage, or death. The use of stimulants such as cocaine, amphetamine, and methamphetamine can cause acute health problems such as stroke, heart attacks, abnormal heart rhythm, and seizures, as well as more chronic conditions such as heart or lung damage. The use of drugs by smoking or vaping (e.g., heroin, crack cocaine, marijuana) can make chronic obstructive pulmonary disease (COPD), asthma, and other lung conditions worse. Other conditions that affect the immune response, such as HIV or liver disease (viral hepatitis), are more common among people who use drugs, especially among those who inject drugs.
For these reasons, it is possible that drug use could make COVID-19 illness more severe, but more evidence is needed.