When the state of Georgia shut down as part of its battle with the COVID-19 pandemic, Gainesville’s recovery community was the busiest it has ever been.
Just two miles from the Jeffrey Dallas Gay Jr. Recovery Center on Juanita Avenue, Northeast Georgia Medical Center and its health system were seeing more overdoses in the first half of 2020 compared to the year before.
"A lot of people that have been pretty established in their recovery are really, really struggling,” said Jordan Hussey, executive director of the recovery center often referred to as J’s Place.
So far in 2020, the Northeast Georgia Health System has seen 324 overdoses overall at its four hospitals. In that same time frame in 2019, the system had seen 301 overdoses, while that number for the same time frame in 2018 was 310.
The health system said it could not comment on whether those who overdosed survived.
The increase also represents a higher percentage of emergency department visits, as overall visits have decreased. Dr. Cory Duncan, medical director of the emergency department at NGMC in Gainesville, said emergency department volumes were down as much as 40% at some points during the COVID-19 pandemic.
Duncan said when an overdose patient first arrives at the emergency department, they are seen by a triage nurse who determines the extent of the overdose. Patients with more severe cases may need to be resuscitated, which involves a call overhead for physicians.
Cases can prevent differently, Duncan said. For example, some may experience cardiac arrest, or be unable to breathe, or are very sleepy and hard to wake up.
The information health care providers have about the patient also varies. Duncan said in some cases, they may know the patient was found with drug paraphernalia or has a history of drug use. In other cases, the situation may be more unclear.
The drugs involved in overdoses have also changed throughout the years, Duncan said.
“The first big wave of opioid overdoses that kind of started in the 1990s really involved, the majority of them, prescription opioids,” Duncan said. “Then, we saw a second wave that kind of began in 2010, in that decade, where we did see a dramatic increase in opioid overdoses that were attributed to heroin. … In the last five to seven years, we’ve seen a big increase in fentanyl. Fentanyl is very difficult, because it’s very, very potent.”
There are not any rapid laboratory tests to detect fentanyl, Duncan said.
Nationwide, overdose deaths increased in 2019 after dipping down in 2018, going from 67,937 deaths to 70,980, according to the Centers for Disease Control and Prevention.
In addition, the Overdose Detection Mapping Application Program, a data collection programwith agencies participating nationwide, has noted an average increase of 20% suspected overdose submissions in the first four months of 2020 compared to the same time last year.
The Department of Public Health is part of the mapping application program and also issued a memo in June regarding increased emergency department visits related to drug overdoses.
Hussey said the number of services offered per month at the Gainesville recovery center tripled between March and April, increasing from 577 to 1,686. That number includes any service including support meetings, groceries and individual coaching.
‘People are suffering’
Avery Nix, who grew up in Clermont, shared his story of addiction to opioids and subsequent recovery journey with The Times.
Nix experimented with oxycodone as a teenager at North Hall High School before moving to intravenous opioid drugs and heroin.
He overdosed at 21 but was brought back to life after multiple doses of naloxone, an opioid antidote treatment.
Nix now works as a marketing and business development coordinator with Eagle Overlook Recovery for Adolescents, a 20-person residential addiction treatment program in Dahlonega.
Nix said Eagle Overlook was 80% full in June, a highwater mark for the group that has usually been around 50% occupied. Nix said it appears that relapse rates are up.
"Based on everybody's wellbeing and mental health, people are suffering,” Nix said.
The isolation that has come with the pandemic has also complicated some people’s recovery, according to Laurisa Guerrero, director of peer services for the Georgia Council on Substance Abuse.
“The main thing that supports recovery is connection. … It’s those connections that really help us maintain our recovery,” Guerrero said. “So, when you take the ability to go to meetings and go get coffee with somebody or just be able to be around other people in recovery, it makes it incredibly challenging to continue on.”
Nix said he felt the recovery community did well to adapt to video conferencing and other virtual means to keep the connection, but he has still seen people with multiple years of sobriety falter.
Hussey and Judy Brownell, director of substance abuse prevention at Center Point, said people may be drinking more frequently than they normally would before the COVID-19 outbreak.
Isolation "completely goes against what people seeking and in recovery are told and taught" about reaching out when in need and keeping connected to your support system, Hussey said.
"If you add in you've lost your job and you don't know where your kid's next meal is going to come from, giving up seems like a viable option and you don't really have anybody to talk you out of it,” Hussey said.
People in recovery can become “complacent and comfortable with our normal routine,” Nix said, going to the same meetings each week and having a sense of normalcy. That sense of normalcy has been threatened by a COVID-19 outbreak that shook up that routine.
Hussey said she believes some people in recovery weren’t reaching out because they didn’t know how or know what options were still available.
"I think because of that, a lot of people have fallen through the cracks. I'm not blaming anyone. I'm saying it caught us off guard,” Hussey said.
In March, The Times detailed the move for J’s Place and other help groups making the digital leap as a result of the coronavirus. Hussey said the center started opening up a few meetings in the last month, socially distant outside with chairs sanitized after every meeting.
"Some of them we have 26 people outside, so we're trying to just remind everybody we're here to support you and part of that is kind of looking out for the greater good of us all,” Hussey said.
She said the online meetings have still been popular, as a recent all-recovery Zoom meeting had roughly 80 attendees.
And while some who have been in recovery for years are struggling during the pandemic, others are still deciding to begin recovering, despite the challenges COVID-19 brings.
“The isolation exacerbates the addiction process, so we’re seeing people that are just starting recovery and finding ways to make it work,” Guerrero said.
The Council on Substance Abuse, a statewide organization that promotes recovery efforts, has adapted by offering virtual support meetings twice daily. A help line is also available from 8:30 a.m. to 11 p.m. every day at 1-844-326-5400. The number is available for calls and texts.
Funding for local resources
As the center was at its busiest this spring, Hussey said J’s Place and the other recovery community organizations across the state also faced potentially devastating budget cuts. She said she wrote to state Rep. Lee Hawkins, R-Gainesville, detailing their numbers and how the cuts would affect the clients they serve.
The cuts would have eliminated the roughly $4 million budget line for recovery community organizations.
"Whenever we have a budget crunch, then we've got to zero in on the most important programs to keep intact as much as possible. And that obviously was one of them, in my eyes, being a health care provider,” said Hawkins, a dentist.
Hawkins said that sentiment was also felt through the House subcommittee on health appropriations during the budget process.
"For us, it was a no-brainer. It was just that we had to work through cuts in other places,” he said.
In the end, the funding was restored in the final budget.
U.S. Overdose Deaths
- 2017: 70,237
- 2018: 67,367
- 2019: 70,980
Source: Centers for Disease Control and Prevention
How NGMC is combatting overdoses
One program available through the local health system aims to help people begin their recovery process.
The ED-CARES peer support program, established in 2017, is a partnership between NGHS and the Council on Substance Abuse. Overdose patients are connected with a peer recovery specialist who can help them find recovery resources and support them through the process.
Guerrero said the program has so far worked with more than 3,800 patients.
Brownell said the Partnership for a Drug Free Hall was looking at other ways to continue their initiative. In past years, the partnership of civic, medical and law enforcement leaders has tried to have a forum in the winter and in the fall.
"We're sort of in that phase of assessment, but we have to do everything by remote (meetings). We had hoped to get together in September to do some real serious planning, but being together is not a possibility even then I think,” Brownell said.
Brownell said they are looking at the possibility of webinars and other virtual means.