We are a global community – like it or not. We are connected down to the minutia of life, from what we breathe, to what we eat, to what we think, to what infects us. And right now, the world, our world is in a life-or-death struggle with a microscopic enemy that seems to keep gaining the upper hand. The result in just one area is massive unemployment and the subsequent loss of access and funding for public and private support services.
I don’t want to get in to the politics of whether economies should be opened up regardless of Covid-19 and suffer the consequences in lives lost, verses lives ruined by no work and massive personal and societal debt. What I am concerned about are the consequences of what so many millions of people are facing from having lost their means of livelihood, and in particular, those whose lives were already balanced on a knife edge on a daily basis.
“If it weren’t for Covid, these opioid deaths are all we’d be talking about right now,” said Natalia Derevyanny, spokeswoman for Cook County, Ill. medical examiner’s office. Instead of overdoses decreasing due to drug supply chains being disrupted, the opposite has happened as drug users have had to search out new tainted supplies where unscrupulous players have found opportunities to make money off of desperate people. Some people thought that with the pandemic, people living with addiction would “decide” it was a good time to get clean. For those who don’t understand opioid addiction in particular – which is physically and psychologically addicting – “wanting” to get clean is not the question. Being able to access the medications and support programs that are needed to get and stay clean is the question.
For individuals living with drug and/or alcohol addiction, many of whom have unstable or non-salaried jobs, unemployment during this time of crisis has three major implications: more anxiety and loneliness from being home and socially isolated; disruption of routine which is integral to the recovery process; and lack of social safety net funding and availability for Harm Reduction such as recovery programs and treatment centers due to new limited spaces because of Covid-19 restrictions, and lack of sterile needle and syringe services. Much of this is true for other countries with substance use problems including Australia, Great Britain, Canada.
Doctors told PBS NewsHour that isolation and anxiety, common substance misuse triggers, along with other added stresses during stay-at-home orders, plus economic hardship, could have an impact on drug overdoses. As early data shows, they have. And, the doctors also report the number of visits to hospitals and clinics are down, as people have tried to avoid catching Covid-19 from medical settings. Thus more opioid overdoses happening in isolation and away from friends who might have Narcan on hand to help prevent death.
“Americans are at high risk now, even those who did not misuse opioids previously… due to worsening mental health and emotional well-being” wrote Dr. Harris, chair of the AMA Opioid Task Force. The AMA issued recommendations for increased access to treatment during C-19 including pushing states to adopt temporary rules from the Drug Enforcement Agency (DEA) that say patients can now be prescribed medication to treat addiction without an in-person visit first, which was a previous barrier to Telehealth services accessed via mobile apps, texting and videoconferencing. Aside from convenience, Telehealth may reduce stigma that some may feel by seeking help in a public or group setting.
The AMA is working with the DEA and the Substance Abuse and Mental Health Services Administration (SAMHSA) on increasing flexibility for physicians to provide patients with buprenorphine and methadone along with helping patients with chronic pain get the medications they need. They also called for further steps to be taken to prevent the opioid epidemic from worsening. You can find them in the article link below.
I’ll end with another quote from Dag Hammarskjöld. He reminds us to not be so preoccupied with our own burdens that we are unavailable to offer what support and real help we can to those who are struggling with mental health and addiction, intensified by loss of income and support during this time of international upheaval.
“What makes loneliness an anguish is not that I have no one to share my burden, but this: I have only my own burden to bear.”― Dag Hammarskjöld