Dealing With Domestic Violence During the COVID-19 Pandemic

It’s official: the demon also known as the year 2020 is finally over! It really seemed that, during 2020, if it could go wrong it did go wrong.

With COVID-19 vaccines in play and a new U.S. administration on the way, there’s a lot to celebrate. And we should definitely take a moment to revel in the wins that are being ushered in with the new year!

But we also can’t pretend that a new Gregorian calendar year, the change in administrations or even the foreseeable end of the pandemic will magically fix all of the issues that came to light, arose, or were exacerbated during 2020. One of those issues is domestic violence. Of course, domestic violence is not an issue unique to 2020—but, unfortunately, many of the issues that helped make the year so remarkably terrible also exacerbated many of the conditions that can lead to violence within the home or make it more difficult for those experiencing domestic violence to getaway.

Domestic violence can take place in a variety of relationship contexts and can be perpetrated by people of any gender against people of any gender. This blog post is mostly focused on intimate partner violence, but the general messaging can be applied toward other forms of domestic violence. Current data indicates that intimate partner violence is committed most commonly by male perpetrators against female targets, although that data may be skewed by collection and reporting biases. For the purposes of clarity, I will be utilizing gender pronouns that reflect this dynamic, but please keep in mind that many violent relationships do not match the statistical “norm.” If you are experiencing intimate partner violence and you are male, gender-queer, in a same-sex relationship, or otherwise do not match the male/female dynamic, this post is still for you. Your experience is valid.

The Effects of Isolation on Domestic Violence

One of those issues were the periods of quarantine and isolation necessitated by the pandemic. Coupled with widespread job losses and exacerbated economic insecurity, these periods of isolation—while necessary to help prevent the spread of the virus—left people experiencing intimate partner violence or other forms of domestic violence even more isolated and vulnerable than they were already.

One of the early warning signs of intimate partner violence is isolation. Often, abusers will cut their targets off from their family, friends, and support networks. This can happen in obvious ways, like an abusive partner demanding his target stop spending with male friends or limit conversations with family members. It can also be more subtle, such as comments denigrating important relationships, or that make her feel unsafe after spending time with other people. This behavior can become so intense that the target may stop communicating with friends and family when their abuser is around, or end communications altogether.  

The social isolation necessitated by the pandemic can make it harder for people in abusive relationships to speak with friends and family, or to reach out for help. If you know or suspect that someone you love is experiencing domestic violence during the pandemic but you’re not hearing from them, reach out yourself. Keep in mind that it’s not uncommon for abusers to have total control over their target’s phones and social media accounts, so make sure any messages you leave could be safely heard by their abuser. 

How the Pandemic Has Exacerbated Economic Abuse

Although often not considered in such terms, intimate partner violence is an issue of economic justice as much as it is social justice or feminist issue; people involved in abusive relationships are known to miss more days of work than the average employee, lose their jobs more often, and remain chronically unemployed as the result of their abuse. When they do earn income, it is common for an abuser to take control of their finances, granting them sparse or no allowances. This is called economic abuse, and some estimates place it as present in 98% of abusive relationships. 

Economic abuse can make it difficult and dangerous for targets of abuse to pull together the funds necessary to safely escape an abusive household. Of course, the coronavirus pandemic has made this problem even more dire. It’s no secret that tons of U.S. households have experienced enormous—and even total—slashes to their income due to pandemic related hour cuts and job loss. In addition, group environments like homeless shelters or even specialized DV shelters have had to cut capacity or, in some cases, close down altogether in order to adhere to local regulations aimed at controlling the viral spread. Even where these options remain available, it is not easy to choose between the danger of intimate partner violence—but the relative safety of a home environment—versus the danger of moving into a group setting filled with strangers during a deadly pandemic. 

For some, selling homemade goods and work-from-home services or hosting online fundraisers may be their only means of generating the funds to get to a safer situation—even if they don’t explicitly state that. Some people have a huge stigma against giving cash to others, even if they are able to afford it. That stigma is amplified when the person in question is currently using drugs or has a known history of use. How you share your money is your own choice, and nobody has the right to demand you use it in any particular way—but I would like to urge you to consider the extenuating circumstances posed by the pandemic, and the fact that many formal emergency charity services are unable to reach the most vulnerable among us. Asking for money is never easy; if you see someone doing it, they are more likely to be in desperate need than lazy or unproductive. 

People Use Drugs to Cope

The fact that people use drugs to cope is nothing new, nor is the fact that there is a high correlation between experiencing intimate partner violence and engaging in both substance use and problematic substance use. Problematic drug use also appears to have gone up during 2020; although final national data are not yet in, jurisdictions around the United States have recorded worrisome spikes in fatal overdoses, as well as increased self-reports of substance use, including alcohol. Although we do not have official confirmation that domestic violence has played a role in the uptick we’re seeing, that doesn’t mean there’s no correlation. 

It’s generally a good rule of thumb not to judge someone who is using drugs in a manner you perceive as destructive: besides the reality that they may view their use through a radically different lens, the choice to use a substance is dynamic and ever-evolving based on the equally dynamic circumstances of their personal life. Add the dual trauma of a pandemic and a violent relationship into the mix, and you have an equation that, for some, may result in substance use. 

If you’re concerned about their use, try sharing your concerns in a compassionate, non-judgmental manner, and making sure (to the best of your abilities) that they are consuming drugs in a safe manner that mitigates the risk of fatal overdose and disease. An earlier blog post I wrote for WorkIt Health last year discusses some harm reduction tips. You can also look to orgs like the Harm Reduction Coalition, Urban Survivor’s Union, the People’s Harm Reduction Alliance, and more for more tips and information on harm reduction. 

Drug Policy Was the Real Winner of the 2020 Election

By now, the doubt that ensconced the nation for the three days after the 2020 presidential election has lifted.

Despite sitting President Trump’s refusal to accept his opponent Joe Biden as the winner, (most of) the rest of us finally know who the president-elect is. But before those results took over the headlines, there was another kind of sweeping win; one that was recognized immediately. That winner was drug policy

How Drug Policy Won the 2020 U.S. Election

As Elizabeth Nolan Brown wrote in her story for Reason covering the events of the November 2020 election, “drugs are winning the war on drugs.” A less sensationalized and more accurate version of that statement is to say that science, drug policy, drug users, and those who love them are winning the war on drugs. Of course, the United States still has an overwhelmingly punitive approach when it comes to drug use, and that’s unlikely to ever be changed by one public election alone. But the law enforcement approach to drug use and addiction definitely took some big hits this election.

Perhaps not surprisingly, the biggest win comes from Oregon, where voters elected to decriminalize all illegal substances—including those typically too demonized to be included in U.S. decriminalization conversations, like heroin. Measure 110, also titled the Addiction Treatment and Recovery Act, effectively reclassified small “personal” quantities of drugs like LSD, cocaine, methamphetamine, and heroin into Class E violations, which carry no more than a simple $100 fine as a penalty. Additionally, the same measure reallocates state revenue from Oregon’s legal marijuana sales toward addiction treatment programs and also to support some harm reduction services.

Oregon’s Measure 110 was an unprecedented trailblazer in drug policy reform. But Measure 109, also out of Oregon, shared more similarities with some of the drug policy wins out of other states. Measure 109 legalized the use of psilocybin (the active hallucinogen in “magic mushrooms”) for therapeutic purposes. The Oregon Health Authority will now oversee the development of a program that will grant licenses to approved medical providers who can then prescribe psilocybin for the treatment of psychological conditions like post-traumatic stress disorder and depression. 

In Washington D.C., the consumption and personal-quantity growth/possession of psilocybin-containing mushrooms was decriminalized, along with other psychedelic plants and fungi, including peyote (which contains mescaline) and ayahuasca (which contains dimethyltryptamine). While the new measure does not explicitly stop police from making arrests related to psychedelics, it ranks them as the lowest priority. 

Other wins include the legalization of marijuana for personal use in New Jersey, Arizona, South Dakota, and Montana. They are joining 11 other states, including Washington, Oregon, Colorado, California, and Alaska in legalizing marijuana use and sales (though regulated) for adults over 21.  Residents of Mississippi and South Dakota respectively voted to also legalize marijuana for medical use. 

What’s the Difference Between Legalization and Decriminalization?

When talking about the need to reform drug policy, it’s not uncommon for people to use the terms “legalization” and “decriminalization” interchangeably. In fact, they are wholly separate concepts. In order to understand last week’s wins, we need to really understand the differences between legalization and decriminalization. 

Drug decriminalization removes criminal penalties from the use of the substances at hand.  So, in the case of marijuana, it is still technically illegal, but it no longer carries criminal penalties like jail time. Also, because it’s illegal, the government can’t permit and regulate its sale. Some anti-prohibitionists feel decriminalization is the better, more anti-racist choice because it could still allow for a black market, which is more accessible than the tightly regulated and extremely exclusive state-licensed marijuana markets we are seeing in states that have taken the legalization approach. Since Oregon has legalized some substances and decriminalized others, it may end up serving as an experimental microcosm of this debate.

Legalization means that the substance or substances in question are fully legal; they are not associated with any kinds of fines or fees, and likewise can’t be used as entry-points for forced treatment programs like drug court. It opens the door for a regulated, legal drug supply, which would mitigate some of the worst harms we’re seeing arise from black market drug use, such as accidental fentanyl poisoning.                   

How Does This Impact the Future of the U.S. Drug War?

State-level drug policy changes don’t directly impact the Drug Enforcement Agency (DEA) or federal policymakers. In fact, if they so desired, the DEA could make a move to raid a legal marijuana shop under federal law, and we have unfortunately seen judges side with the feds. But the voice of the people matters—and this year, voters in these key states made their voices LOUD. These changes send a clear message that the American public is tired of watching our friends, family or our own selves fall victim to a relentless, Drug War driven by mass-hysteria and a purposefully cultivated ignorance of science. Oregon in particular has a chance to demonstrate the benefits of decriminalization, as well as what government dollars can do when applied to evidence-based approaches like harm reduction.        

Dear Advertisers, Please Stop Saying Alcohol is the Solution to Pandemic Stress

Alcohol’s legality has long promoted a sense of normalcy around its use, while illicit drugs are demonized as harmful, dangerous, and addictive poisons that turn their users into amoral, selfish monsters.

This dichotomy ignores the reality that alcohol can be just as harmful as many of those substances society has labeled “extreme,” and sometimes even more so. For example, repeated, long-term alcohol use will lead to a physical dependence similar to opioids like heroin and fentanyl. 

Unlike opioids, however, alcohol withdrawal can produce life-threatening seizures and other symptoms in otherwise healthy adults. Alcohol poisoning can likewise be fatal, or produce debilitating short and long-term side-effects. Alcohol consumption is associated with a host of health issues, and contributes to more than 10,000 automobile deaths per year. Yet despite these obvious harms, alcohol continues to enjoy a reputation as a safe and socially acceptable form of stress relief. Now, it is even being touted as a balm for coronavirus and other issued related to lockdown.

From in-store promotions to targeted online advertisements to memes, wine and liquor are being celebrated as heroes of the pandemic. Of course, alcohol advertisements are nothing new, nor are memes celebrating wine and spirits (particularly in the context of white, upper-class parenting stress). And hey—during a time period when bad news and extreme anxiety have become our daily baseline, isn’t humor a good thing? The answer is yes; laughing and finding the humor in a situation in which we have very little control is much healthier than wallowing in despair. But addiction is no laughing matter and it is particularly harmful to make alcohol consumption the brunt of the joke right now.

Pandemic Parenting is a Major Problem for Everyone—but the Difficulties are Not Equally Distributed

All you have to do is look at some of the alcohol-fueled homeschooling memes floating around to be clued into the problem: these memes are populated by upper-class middle-aged white people smiling covetously around glasses of spirits. These memes showcase a deeply harmful disparity that causes real harm in the lives of parents around the United States: upper class, typically Caucasian, are given license when it comes to the consumption of substances to mitigate parenting stress. Low-income parents, especially low-income parents of color, are subject to child services investigations on mere allegations of substance use—much less for joking online about balancing their newborn on their legs during redwine yoga, or for chugging whiskey 11 minutes into the homeschool day. 

Alcohol Addiction Is No Joke

Despite what popular media would have us all believe, alcohol addiction is no laughing matter. Although most people who consume alcohol are able to moderate their use and enjoy it in a safe manner, there are some who seriously struggle to moderate their use. For those who develop an addiction to alcohol, it can cause serious damage to their life, bodies, and mental health. The coronavirus era memes and grocery promotions around alcohol use go beyond mere advertising—they are actually joking about addiction. Some making the choice to stock their fridge with wine instead of buying toilet paper, or choosing to drink at 11am to cope with the difficulties of homeschooling, or labeling liquor a “school supply” are all behaviors that, were they serious, would indicate an unhealthy relationship to alcohol and likely an addiction. Joking about behaving like someone with an addiction isn’t really funny—it’s hurtful, shame-inducing, and it contributes to stigma.

You Might Be Triggering Someone Who Is Genuinely Struggling

It’s difficult to know exactly how the pandemic has impacted our relationship to substances, but some preliminary data from several counties indicate that substance use has gone up. That includes alcohol sales. And some predictive algorithms, including a projection from Well Being Trust, are providing a grim glimpse into a possible future outcome that includes increased deaths from alcohol and other drug consumption. People are genuinely struggling right now. And while it’s important that we all learn to recognize and take charge of our own triggers, we also need to collectively recognize that this is a high stress time during which many people have decreased access to addiction and mental health support. So instead of making things harder on those who are struggling because we want a quick, cheap laugh, why not just exercise some empathy and avoid the triggering memes?

The High Cost of Reducing Harm Reduction in 2020

2020 has been a year of unprecedented stress.

Global pandemic. Social isolation. Political unrest. Personal loss. Economic upheaval. National division. Rampant civil rights violations. Rampant physical and mental health complications. Sociopolitical, economic, and (if you’re anything like me) personal disorganization. Career instability. Housing instability. Injustice. Depression. Grief. Anxiety. Loss, loss, and more loss. We have collectively taken to greeting each other with statements like “hope you’re relatively well,” or “I’m alright, all things considered,” and our customer service representatives now end calls by telling us to “stay safe.”

All of these factors alone would more than account for a surge in problematic substance use—but there’s more at play. In addition to our collective stress, people who use drugs—particularly those who use drugs chaotically—are having to deal with a whole other set of problems. Many harm reduction providers around the United States have had to reduce or shut down services due to staffing shortages, funding issues, state or jurisdictional guidelines, or infection control needs. Treatment providers have struggled to meet the surge of demand during this acutely stressful time. While some of the more restrictive regulations were lifted for methadone and buprenorphine providers, not all providers chose to change their own practices, or only did so on a temporary basis for certain patients. Other types of services, like detox, inpatient rehab, and sober housing raised entry regulations in attempts to protect current patients from contracting the novel coronavirus. Illicit drug supplies have grown increasingly unstable, and even some legal harm reduction services have experienced difficulty accessing supplies, such as those reported by Nicole Reynolds, a freelance street-based harm reduction provider in North Carolina, who said she has had to resort to buying small syringe supplies from local pharmacies a few times over the course of the pandemic due to under-stocked bulk carriers. 

The result? An uptick in substance use, recurrences of chaotic substance use, fatal overdoses and other deaths of despair. These outcomes have been predicted by statisticians like Well Being Trust, confirmed by preliminary numbers from various counties around the nation, and reflected in individual anecdotal reports

A Cost Already Too High

With counties across the country reporting spikes in the numbers of fatal overdoses this year, we can already see that the cost of reducing harm reduction and treatment services during a time of increased anxiety is already too high. Unfortunately, the harm reduction community has recently been forced to experience a visceral reminder of this too-high cost. Several prominent, respected, and beloved harm reductionists have lost their own lives this year to the instability and despair produced by the criminalization of drug use and the other extreme stressors of 2020. I was privileged enough to know two of those people: Dylan Stanley and Jesse Harvey.

Dylan Stanley was the director of human outreach at Harm Reduction Ohio, an avid harm reductionist, and personally responsible for reversing more than two dozen opioid overdoses, and for distributing even more life-saving doses of naloxone to others. Above all else, she was a mother. This was how we met—she and I shared similarly biased and unjust child services cases around the same time. Though we never met in person, we bonded online over this deep, shared trauma, and our deep, overwhelming hopes that we would both be reunified with our beloved children. Her friends describe her as compassionate, spunky, energetic, creative, beautiful, loving, beloved, inspirational, and a force to be reckoned with.

Jesse Harvey was the founder of the radical Church of Safe Injection. Based out of Portland, Maine, where syringe distribution was hotly contested and not always legal, he provided services even when it meant risking his freedom because his ideal of a harm reduction church was no mere gimmick: Jesse was a true believer. I knew him as a source; he was always happy to slip me a tip or a story because supporting drug user-led journalism was important to him. He went out of his way to connect me with people who could help strengthen my stories, expecting nothing in return but that the truth be told. Even though I did not know him well, I knew he was an idealist at heart. His friends describe him as passionate, hard-working, and dedicated—but also goofy, creative, hilarious, and an overall role-model.

Dylan Stanley and Jesse Harvey represent just two of thousands of lives lost this year—but their losses will be felt by their communities for generations. Those who were also lost this year for similar reasons  but not mentioned here were, I am certain, equally important to those who loved them.

What Can We Do? 

There are several policy decisions that can and should be made to reduce this untimely and unnecessary human cost, like opening safe injection sites across the nation, making evidence-based treatments more physically and economically accessible, ending the criminalization of drugs (if not legalizing them altogether), removing drug use as a criteria for child services involvement (if not abolishing the foster industrial complex altogether), investing in better social supports, and so on. 

But what about what we can do on an individual level, today? Going back to the basics of harm reduction, we can make sure people are not using alone, and that naloxone (the drug that can reverse an opioid overdose) is available anywhere and everywhere it could potentially be needed. If you or someone you love is in quarantine or are otherwise forced to use alone—there’s an app for that! Well, actually a website and phone number. Neverusealone.com, also accessible on Facebook or at 1-800-484-3731 (backup number: 931-304-9452), is available to people in the continental United States who are using substances alone. They promise to “never shame, judge, or preach to stop,” but add that “if you are interested in getting help, we have resources available for you, but we will never push them on you.” They ask for your location, and if you become non-responsive after using, will send emergency services to check on you.

If you are addicted to opioids, medications like methadone and buprenorphine have a strong evidence-base for reducing or discontinuing harmful, unwanted opioid use. A relaxation of regulations in the United States this year have made these medications easier to access in some cases. Buprenorphine, in particular, is now able to be inducted via telehealth, meaning patients can start from home. The presence of illicit fentanyl in many street supplies (including non-opioids like pressed benzodiazepines and cocaine) has made buprenorphine induction particularly difficult; if you are having trouble getting on buprenorphine, talk to your provider about the possibility of microdosing

If you’re using substances, practice safe use hygiene as much as possible. Don’t share your injection supplies with anyone, including cookers, as blood-borne illnesses like HIV and Hep C can be passed even when you can’t see any blood. Sharing smoking and snorting equipment comes with risks too (especially during the pandemic), so try to always use your own equipment. If you’re forced to share smoking or snorting tools, sterilizing between users with bleach or isopropyl alcohol is the next best option. Wear masks and gloves to supply runs. If you can, test your drugs for fentanyl, even if you’re not buying an opioid.

And practice mental health hygiene too! Whether you’re abstinent, using, in recovery/remission, or in another category altogether—you matter. If you’re struggling, reach out for help. If you can’t see friends in person, talk to them online or on the phone. Find activities you enjoy; maybe try a new knitting webinar, or finally crack open that reading list. Just because you might be home more, doesn’t mean you have to be super-productive; if you lose a day to Netflix, don’t be harsh on yourself. We are all under unprecedented stress. Self-compassion is as important as caring for your community. 

How COVID-19’s Stimulus Privacy Laws affected People in Recovery

2020 has been a big year. From the viral pandemic, to the economic shutdown and resultant armed protests, to an uptick in racial violence and the resultant protests and  subsequent severe government response, to increases in drug overdose deaths.

It can feel impossible to try to keep track of every change or significant event that’s taken place this year. But if you’re an addiction treatment patient, there has been one quiet set of changes that you should definitely be aware of. Particularly if you are taking medications for opioid use disorder.

A little known effect of the CARES Act.

When the Coronavirus Aid, Relief, and Economic Security Act passed (CARES Act) in March, it included changes to 42 CFR Part 2 of the Social Security Act. This is the part that covers privacy protections for substance use disorder patients. These changes were passed as a rider to the CARES Act titled the Protecting Jessica Grubb’s Legacy Act. This rider move SUD patient privacy closer to general HIPAA regulations by removing the consent requirements for information re-disclosure. Previously, patients had to consent each and every time their protected health records were shared or discussed with another provider. This meant that if a patient signed a consent for her buprenorphine prescriber to discuss her scripts with her psychiatrist, her psychiatrist would require a specific, explicit consent before discussing her buprenorphine information with, say, a primary care physician.

Now, once a patient signs consent, that information can be re-shared into perpetuity. It may sound like a relatively small change, but it’s not. It essentially means that all SUD information can be shared without a patient’s knowledge. Many patients have to sign consent forms to their insurance provider, for example. Or so that their methadone prescriber can communicate with their endocrinologist or anesthesiologist or any number of other providers. Now, that information can continue being shared for as vague a reason as “healthcare administration.”

HIPAA doesn’t protect your privacy like you think.

Some patients hear this and say, “Well, hey. At least we have HIPAA.” But in fact, the Health Insurance Portability and Accountability Act (HIPAA) doesn’t really work the way people think it does. Danielle Tarrino explains this in TalkPoverty. She is president and CEO of Young People In Recovery, and a previous employee at the Department of Health and Human Services. While at the DHHS, she drafted the 2017 revisions to 42 CFR Part 2. She says, “HIPAA is not a [patient] privacy protection. It’s actually an authorization to share your info as broadly as a health care payor believes they need to share it, which I will tell you is very broad.”

Zac Talbott, president of the National Alliance for Medication Assisted Recovery (NAMA Recovery), said in the same article, “You’ll hear people say, ‘that violated HIPAA.’ Actually, it violates Part 2, and it’s now gone.”

SAMHSA update allows greater access to databases.

In addition to this change, the Substance Abuse and Mental Health Services Administration (SAMHSA) also updated their rules under 42 CFR Part 2. This included permissions for opioid treatment providers to include patient records to state prescription drug monitoring programs (PDMP). The PDMP exists to help regulate the prescribing of controlled substances like opioids. But many people feel it is a violation of their privacy, and that it is used to discriminate based on the substances a patient is prescribed. Law enforcement agencies have even sought and been granted access to PDMP databases. This becomes especially problematic when addiction patients are involved, since addiction typically involves an illegal act under current U.S. law. 

Prior to the SAMHSA update, which just took place in early July, opioid treatment providers were required to search for their patients in the PDMP to ensure they were not being prescribed any substances that could negatively interact with their methadone, for example. But they could not add them to the database. These patients already face stigma in the form of criminalization, child removal, employment discrimination and more. They are even more likely to face these consequences if their data is leaked through the PDMP or a records redisclosure.

What is the impact of these changes?

Providers fear that patients will be less inclined to seek treatment, knowing their information is not confidential. 

“Why would I go to treatment if they are going to blab my business all over town? We have a conundrum: We want people to go to treatment, but we are going to discourage people from seeking treatment by telling them ‘your privacy is irrelevant,’” TalkPoverty quoted Westley Clark, Dean’s Executive Professor in the Department of Psychology at Santa Clara University and the former director of the Center for Substance Abuse Treatment (CSAT) within SAMHSA as saying.

If you are a patient and you are concerned about your privacy under the new rules under SAMHSA, patient advocacy groups like the National Alliance for Medication Assisted Recovery and others are continuing to lobby for better privacy protections. NAMA-R is accepting members and has local chapters in every state. You can also check with the Urban Survivor’s Union or your local harm reduction agencies. Ask them about more ways to get involved in patient advocacy.

Getting Through An Alcohol Detox

For anyone who wants to recover from a substance use disorder, discontinuing use can be one of the scariest first steps.

That looks different for different people and different substances—for some, it means intense psychological cravings and fatigue. For those addicted to dependency-producing substances, physical withdrawals add another difficult and painful component. Alcohol withdrawal in particular offers serious problems—both serious discomfort, and serious medical risks. But it is possible to detox from alcohol at home, and WorkIt Health now offers a program to help patients begin this crucial first-step if they are seeking alcohol abstinence.

What Are the Risks?

It’s important for those who wish to pursue abstinence from alcohol to realize that alcohol withdrawal, unlike the average opioid withdrawal, can be life-threatening, including seizures. Delirium tremens (DTs) are another highly dangerous symptom of alcohol withdrawal, which occur in about 5% of patients, and can produce hallucinations, delirium, racing heart, high blood pressure, and fever. People with a history of experiencing DTs or withdrawal-induced seizures are not able to participate in the WorkIt Health monitored home detox program. For these patients, it is suggested they attend a medically supervised inpatient detox program. Inpatient programs often monitor patients while utilizing a combination of seizure prevention meds like benzodiazepines.

If an inpatient detox is inaccessible, it is possible for heavy or high-risk drinkers to taper their alcohol use at home. This is not part of the WorkIt Health protocol, and it is recommended they not attempt this alone, or at least keep in contact with a trusted friend. From Filtermag.com: “Tapering, if that’s your goal, should be done with the aim of avoiding withdrawal, not getting intoxicated. So drinkers should consume only as much beer as is absolutely necessary to hold off shaking and sweating.”

Milder symptoms of withdrawal include tremors, sweating, anxiety, vomiting, and insomnia. These symptoms do not disqualify a patient from the WorkIt Health home detox program and are generally expected of patients who have an alcohol dependency. Although WorkIt Health will monitor patients for short daily periods, it is recommended that anyone attempting a home detox have a trusted friend or family member present to help monitor them and make sure that a medical professional can be reached should they begin to experience more serious withdrawal symptoms.

How Can Withdrawal Discomfort Be Alleviated?

Unlike opioids, there is not an alcohol-based substitution therapy that fills the same receptors as alcohol and helps prevent withdrawal. Tapering alcohol can help prevent withdrawal by gradually lower one’s alcohol intake, but can be difficult to accomplish for those who have trouble controlling their alcohol intake. The time it takes to fully detox varies by person, but can last up to five days.

During withdrawal, it is helpful to stay in a quiet, calm environment away from lots of people. Have plenty of fluids on hand (and a container to suddenly discharge them in). Music, television, books, or other forms of entertainment can be great for helping get through insomnia without spiraling too deeply into your thoughts and anxiety—but some people may prefer quiet and solitude. It’s really up to the individual.

WorkIt Health patients may be offered gabapentin, which is a nerve-pain medicine that acts on the gaba receptors and has calming properties, as well as naltrexone, which helps block the effects of alcohol. Patients who take naltrexone cannot have any type of active opioid dependency, or it will produce severe precipitated opioid withdrawal. Patients who cannot take naltrexone because they have opioids in their system may be offered Librium instead.

For patients who are not participating in a medically supervised detox, it is important to stay hydrated with water, and electrolyte drinks like coconut water or sports drinks. Healthy food can also help keep your body functioning. You may not feel like eating, but if you can make yourself eat a few pieces of fruit or something simple like yogurt or soup, it will help keep your body as healthy as possible during this time. Anyone who begins to experience significant hallucinations or seizures should seek emergency medical assistance immediately.

Does Naltrexone Show Up on a Drug Test?

If you are thinking of trying naltrexone treatment for alcohol or opioid use disorders, you might be wondering if it can be detected on a drug test.

There are many reasons why someone could be concerned about a medication being detected on a drug test. Perhaps you are required to take drug tests for work and you are concerned that you might experience discrimination if you admit to being in recovery from a substance use disorder. Or maybe you are on probation or in drug court, and you are not certain whether this medication will be accepted. Or you might simply be curious.

OK, So Can Naltrexone Be Detected?

The short answer is yes: any substance that is metabolized in your body can be detected by a drug test. But in most cases, the functional answer is no. When someone says “drug test,” that can mean a variety of testing types. In the workplace, drug tests are usually administered by taking urine or saliva. In court cases, urine and hair testing are common, though blood and saliva may also be utilized. For alcohol detection, breathalyzer tests are also commonly employed in a variety of settings. 

Sometimes, urine and oral fluid (saliva) tests are conducted onsite, with automatic results. These are immunoassay tests, which use antibodies to detect the presence of a substance in the sample. They are referred to as screening tests because, although they can accurately identify the presence of certain drugs, they are also prone to false positives and other errors. If a screening tests comes up positive, it should be followed with a confirmatory test, conducted in a lab by gas or liquid chromatography-mass spectrometry. 

All of this is relevant because, typically, in order for a drug test to detect a substance, that substance must be specifically tested for. Naltrexone is not included in any of the typical testing panels, so it should not turn up—unless whomever is testing you specifically requests it for their own purposes. If you’re concerned that naltrexone is being tested for, you can always ask what type of panel is being conducted and what substances are included. 

That said, however, it is possible for naltrexone to show up as a false positive on a screening test. A letter published in the Canadian Journal of Addiction Medicine in 2019 discusses some anecdotal evidence that naltrexone has occasionally screened positive for oxycodone or opiates. They attribute this to the structural similarity between naltrexone and oxycodone, but also note that there are no peer-reviewed studies to back these anecdotal findings.

What Are My Rights?

If you are being asked to take a drug test, you can decline to provide the sample, but you will then have to face the consequences, whether that means you don’t get the job you want, or get your probation violated. If you’re having trouble with the particular type of drug test requested, you may be able to request a different form of test, depending on who you are dealing with. For example, if you’re unable to provide a urine sample (which can be particularly difficult in the case of witnessed urine screens), you might be able to ask to do a blood or oral fluid test instead. Generally speaking, however, that request does not have to be granted, and you may need to take the matter to court if it’s serious.

When it comes to the use of naltrexone, it is an FDA approved, evidence-based treatment for opioid and alcohol addictions. This means that if you are taking it as prescribed by a licensed medical provider for a diagnosed opioid or alcohol use disorder, you are protected against discrimination by the Americans with Disabilities Act. That means nobody can, for example, deny you a job or say you’re an unfit parent solely based on the fact that you are taking naltrexone. When it comes to employment, the catch is that you have to disclose your medication in order to be protected. If you were to get one of those rare false positives for oxycodone and then attribute it to a previously undisclosed naltrexone prescription, even if your employer verifies that the screen was false, he could fire you for “dishonesty.” 

When it comes to something like drug court or probation, they typically get to make up their own rules. If you have a particularly dedicated attorney, she might be able to fight for your right to take a medication that is not typically allowed in your program. But this isn’t as much of an issue for naltrexone as it is for buprenorphine and methadone. In fact, naltrexone enjoys the approval of many criminal justice and family court systems because it is not opioid-based and blocks the effects of opioids. This is rooted in stigma; opioid-based medications like buprenorphine and methadone are highly effective and do not result in intoxication when taken properly—but in this case, the stigma benefits people who use naltrexone.

That said, admitting to someone like an employer that you use naltrexone essentially means admitting that you have a substance use disorder. While it is illegal to discriminate against someone based on their diagnosis alone, discrimination can be hard to prove, especially in more subtle forms. If you think your work environment would not be supportive of your naltrexone use, but you are required to pass a drug test, it is entirely up to you whether you want to take the relatively small risk of a false positive that might potentially require you to disclose your medication. 

If you’re unsure whether naltrexone is being tested for at your facility, just ask! The reality is that, in most cases, it is not.

 

Harm Reduction Tips For Alcohol Use

 It is absolutely possible to practice harm reduction for any substance, regardless of legality or reputation. That includes alcohol.

What do you think of when you hear the term “harm reduction?” If the first things that come to mind are syringe exchanges, naloxone distribution, or supervised consumption sites, you’re not alone. To the general public, the term “harm reduction” has become almost synonymous with “making IV drug use safer.” But the actual concept of harm reduction is much, much broader. Even seat belts are harm reduction! 

Harm reduction for alcohol already has one positive factor on its side that many other substances do not enjoy in the United States: Alcohol is legal. Of course, that wasn’t always true. And when alcohol was prohibited, we saw many of the same problems we see now with other drugs, like tainted supplies. These days, you can buy legally manufactured, government-regulated booze from the store. So you don’t have to worry that it’s going to be way stronger than expected, laced with other substances, or produced improperly. If you are over the age of 21, you don’t have to worry about running into legal trouble just for buying it, either. 

Here are some other harm reduction tips to help keep your drinking safe and in moderation if you wish to use alcohol:

Drink plenty of water.

I know, it sounds so basic! But you would be surprised what a huge difference drinking enough water can make. And people so often forget to do it. Staying hydrated will help you better process the alcohol you’re drinking, and prevent a terrible hangover the next day. Try having a glass of water in between drinks. In addition to helping you stay hydrated, this practice will also help you slow down and moderate your drinking. Ending the night by chugging a sports drink like Gatorade, Vitamin Water, or something else high in electrolytes like coconut water, can also help you avoid a hangover the next day.

Don’t drink on an empty stomach.

If you’ve ever engaged in chaotic alcohol use, you probably followed the opposite rule. Drinking on an empty stomach can help you feel more intoxicated faster. But if you’re trying to use alcohol in a safer and more conscientious manner, it’s a good idea to eat while you drink, especially food that is high in fat. Yes! You do have a good reason to binge on fries tonight! Having some heavy, fatty food in your stomach will slow down your body’s absorption of the alcohol. This in turn will help prevent alcohol poisoning or other types of over-intoxication. Keyword: help. Eating a burger doesn’t mean you can then take ten shots in two minutes and expect to be fine!

Arrange safe transportation in advance.

The advent of ridesharing has made the concept of designated drivers something of a relic. But it’s still a good idea to know how you’re getting home in advance. Make sure you have your preferred app set up and ready to use, your phone charged, and enough funds to get you home. Or if you are utilizing a designated driver, set that up clearly in advance. It’s a good idea to make sure your designated driver really wants to play that role, or at least is genuinely willing not to join you in having a couple of drinks.

Have a plan—Set a limit in advance.

If you have a history of chaotic alcohol use and know you might have trouble moderating your use, it’s a good idea to plan for this in advance. It’s going to be a lot harder to tell yourself to stop when you’re already feeling woozy, and a lot easier to tell yourself to keep going. Before you even get near the alcohol, create a plan for yourself. Figure out your safe limit. You can base this on past use, or measure it by personal factors like gender, weight, and health. Determine how you want alcohol to make you feel that night—are you going for a buzz, tipsy, or drunk? (You’re probably not practicing harm reduction if you aim for blackout wasted.) Pick your goal and then set a limit as to how much you’ll need to drink to reach it, and what you’ll be drinking. If you can, tell someone you trust so that they can help keep you accountable

Try to also plan around your potential triggers. What might cause you to drink to excess? Think about them in advance and come up with a response using the tools you prefer. This might be a mindfulness practice, phoning a buddy, ordering tasty virgin drinks, leaving the party early, or something else.

Don’t try to match other people’s drinking.

If you were using heroin, it would be considered crazy and reckless to try to match a more experienced user’s shot. Everybody understands that heroin is based on personal tolerance. People don’t try to inject each other ‘under the table.’ They understand that whoever ended up under the table might never get up again. 

But for some reason, with alcohol, it’s super common for people to attach weird bravado to being able to consume more than someone else. They often engage in dangerous drinking contests to try to see who gets way too drunk first. It’s okay to play drinking games if you’re able to watch your limits, but don’t try to match other people’s drinking in order to feel cool. It’s not shameful to have a lower tolerance than your friend! Nor is it wrong to just not want to get super drunk that night—even if your friends do. There will always be more opportunities to go out, have fun, and drink booze. You do not have to consume all the alcohol in the room in one sitting.

Home With Young Kids During the Pandemic? Here’s Some Tips and Tricks to Help You Stay Sane

Widespread school closures in response to the coronavirus pandemic means that if you’re a custodial parent or caregiver, you’re probably home with your kids right now. Which means you have a lot more family time on your plate than normal.

Especially if you have young children or children with developmental delays, interruptions in school and daycare means it’s on you to keep them safe and entertained all day, while still maintaining your own mental health. 

Combine Self-Care with Play Time

This is my first pandemic, but living with post-traumatic stress disorder and sometimes severe social anxiety means I’ve definitely been stuck at home with young, energetic kids who needed more structure than being let loose to bounce off the walls. You probably already know that, when it comes to young children at least, they are more likely to stay engaged with a task if you’re doing it with them (the opposite is probably true for many teenagers, but that’s a different discussion altogether). One thing I discovered is that you can often combine playtime with self-care to manage your personal anxiety while entertaining your kids. 

Exactly how you do this is going to vary based on your children’s ages, what they like to do, and what you have access to at home—but it absolutely does not require tons of money and resources. For example, ubiquitous toys like play-dough and Legos can be easily transformed into anxious adult stress-relievers while providing your kid’s activity. Play-dough makes a great stress ball; if you’ve never squished play-dough creations between your fingers while anxious, stressed, or angry, you might think it sounds ridiculous, but don’t knock it til you’ve tried it. The caveat, of course, is if your kids have a tendency to rub play-dough into your carpet, it might end up causing more anxiety, in which case you might want to find a less-sticky replacement.

Toys that click together like Legos can be oddly hypnotic and calming too. That goes for both energetic kids and frazzled adults. Don’t get too attached to whatever you create with them though, because your little one will probably end up smashing it. Or you can smash it…Legos are relatively easy to clean up and smashing things can be really cathartic, especially when they’re designed to break apart and you don’t end up really destroying something.

Family activities that get the whole house moving are also great. Put on some of you and your kids’ favorite tunes (or alternate, if you don’t share taste in music), and throw a mini at-home dance party. Get some of that energy out. If you have a yard, go outside and kick a ball around. It sounds simple, but when you’re stuck at home it can be easy to forget that it’s still important to get up and move your body. Exercise releases endorphins, which help regulate your mood. It will also help tire those kiddos out, and that will lift your mood too. 

Remember that the stay-at-home orders relate to limiting contact with other people. The novel coronavirus is not airborne, so you can go into your backyard, porch, balcony, patio, front stoop, stand next to your open window, and so on if you aren’t sick. Current recommendations are saying we should stay 6 feet from others, although some reports are now saying the virus may be able to travel farther. As always, use your best judgment and weigh the risks versus benefits of spending time outside. If you’re able to keep your distance from others while in your yard you should be okay. Just try not to touch your face, and make sure to wash your hands when you go back inside.

Make Important Things Fun

You’ve been teaching your kids how to wash hands all along, and if your kids are anything like mine, it’s been a struggle all alone as well. I can usually get them to touch a piece of soap to their palm and dip their hands under the faucet, but actual proper handwashing takes direction and reminding. It’s more important than ever now and depending on your child’s age, you might not be there every time they need to wash their hands. 

Kids understand the danger to an extent, but it can be easy for them to forget what they need to do to stay safe in the moment. Telling them to wash their hands and why is important, but probably not enough. So make washing hands fun! I tried to get my daughter to sing “happy birthday” twice as her school recommended, but she just asked whose birthday it was. She was not into it. You might have to get creative. If there’s a song they really like that’s long enough, belt it out with them. Or make up a handwashing song together, extra points if it involves butts or snot or one of the other weird gross things that kids inexplicably love.

If they are practicing numbers or spelling, utilize those skills to help them wash their hands—but make sure they don’t cheat. My daughter likes counting and showing off, so asking her to count to twenty while she washes her hands helps—but at about 12 or so she starts through the numbers.

Utilizing tools like extra-foaming hand soap is also helpful. If kids feel like handwashing time is actually play-with-bubbles time, they’re going to enjoy it much more than they will if they think it’s just some chore. Fun scents also help; that way they can show off their accomplishment by having you smell their hands.

Keep Your Medications Secure

If you have kids and take medication for opioid use disorder, it’s always important to keep your medication secure and out of little hands and mouths. Pink liquids and orange film can look especially attractive to kids, and cherry or orange flavoring might taste yummy—even if the idea that your medicine could taste good to someone might be ludicrous after dealing with it every day. 

If your medicine comes in a fun color or shape, it’s imperative that you make sure your kids don’t get hold of it. If you have a buprenorphine script or methadone takehomes, you should already have a lockbox or other secure storage for your medicine (if you don’t, now is a great time to set that up). But now, many patients are dealing with more quantities of medication at once than ever before, coupled with more time at home with the kids. Vigilance around who can access your medication is more important during this time than ever.

If your kids are old enough to self-administer first-aid, you may want to consider keeping your methadone or buprenorphine in a separate place from your other medications. It’s a good idea to keep them secure in a locked container. If that’s absolutely impossible for you right now, put them out of reach and out of sight. 

You know your child best. Some young people will do anything and everything to defy their parents, and telling them not to take your medication might do more to inspire them to steal it. But if your kids tend to listen, it might be a good idea to let them know what your medicine looks like, that it’s not candy, and that in fact, it is poisonous to kids. I don’t generally recommend scaring kids, but in the interest of safety (and because it’s true), employing a few minor scare-tactics around taste-testing mommy’s methadone might be okay.

Don’t Judge Yourself Too Harshly

We are all under an unprecedented amount of stress and anxiety. So don’t judge yourself too harshly as a parent. If you’re letting your kids utilize more screen time than normal in order to let yourself get work done or just get a break, don’t feel guilty. It’s okay to let your kid have an extra cookie because you want to see her smile (you might pay for it later though when the sugar hits her bloodstream). We are all facing anxiety, uncertainty, and stress. We all feel bad that our kids aren’t seeing their friends. We are all making concessions to get through the day. What’s important is that you and your family stay safe—and sane. Don’t sweat the small stuff.