by Tee Wicks
COVID-19 is not the only epidemic sweeping America, and it certainly is not the only public health emergency threatening the lives of millions. Accidental drug overdose is the leading cause of death in Americans under the age of 50, exceeding fatality rates of gun violence and car accidents combined. Opiates, a sedative substance for pain relief, account for the bulk of these overdose-related deaths. This social and politically neglected reality is known as the opioid epidemic. The opiate crisis derives from the nationwide misuse of and addiction to prescription painkillers, illicit opiates, and synthetic forms of opioids. Importantly, with implications for public health practice, the opioid epidemic has largely been framed as a ‘white epidemic’.The crisis has resulted in substantial rates of accidental overdose, hospitalizations, and mortality, killing an average of 130 Americans a day. The opioid epidemic is a preventable social problem that has been thrown on the back burner of legislation and public awareness for years, and its collision with COVID-19 will plague those struggling with substance abuse in the United States at an unparalleled level.
The novel coronavirus is a life-threatening viral infection with a fast-moving fatality rate far greater than seasonal flu. Patients with serious cases of COVID-19 experience side effects that include persistent coughing, wheezing, shortness of breath, chest pain, fever, and fatigue. Little information presently exists on COVID-19 and it’s interaction with opiate users, however, it is clear that there is a dangerous link between the two. The use of opioids create unrealistic feelings of euphoria but cause very real, physical side effects such as sedation, respiratory depression, weakened immune system, and a lack of oxygen to the brain. Because the coronavirus attacks the lungs and respiratory system, high-dosage opiate users are susceptible to detrimental repercussions due to impaired lung capacity and slow levels of breathing. On average, more than two million Americans misuse opioids. With that being said, this information suggests that more than two million youth and adults in the U.S. are a high-risk group of severe illness to the virus.
COVID-19 has universally disrupted lives amidst nationwide quarantine and the enforcement of shelter-in-place laws. Social isolation is key to slow the spread of the virus, however, social distancing is a privilege that many current drug users and reformed addicts cannot afford. Addicts and former users rely heavily on the solace of support groups, such as AA or NA, and other socially supportive environments for recovery, maintaining sobriety and preventing relapse. Social isolation, disconnection, and drastic changes in routine increase the chance of overdose and places recovering users at risk of relapse. In light of COVID-19, active users are faced with obstacles on account of the closure or restricted hours of needle exchange operations and treatment facilities. Individuals already undergoing addiction treatment that are reliant on Methadone, a replacement pain reliever used to treat opiate use disorder, are faced with similar complications. The only way to receive Methadone is through specific methadone clinics that require in-person drug testing and daily monitoring of medication. Although alternative guidelines were enabled to permit prescription fills for two to three-week intervals, these methods have been inconsistent. Witnesses from a Minneapolis methadone clinic reported waiting rooms packed with patients and long queues extending in and outside of the facility. These backward attempts not only exhibit restrictive healthcare access and broken treatment systems but also place immunodeficient users and staff members in a state of vulnerability. Efforts to contain the virus and flatten the curve are necessary, but these tragic circumstances will reinforce and spread the flame of the opioid epidemic like wildfire.
Americans facing COVID-19 have, and still are, experiencing radical losses of income, mass and long term unemployment, fears of contracting the lethal virus, and a fundamental, bleak hope for the unprecedented future. Millions of substance abusers, former addicts, and even non-addicts might be inclined to self medicate with drugs or alcohol in order to cope with pending fear and socioeconomic unease brought upon by the pandemic. The National Institute on Drug Abuse states that “environmental and social stresses are an important predictor of many mental disorders and these stresses increase the risk for substance use and even make the brain more prone to addiction”. It is imperative to note that the opioid epidemic disproportionately and overwhelmingly attacks individuals with insecure housing, poor education, criminal charges, inadequate or lack of healthcare, and those of low socioeconomic status. An investigation conducted by The National Institute of Health found that individuals living below the poverty line represented 24.6% of opioid overdose deaths, in which only 11.7% were alive by the study’s completion. All of these socioeconomic factors contribute not only to the risk of addiction but to contracting and spreading COVID-19. Similar to the opioid epidemic, the coronavirus affects individuals from all walks of life but largely threatens low-income communities with a lack of economic mobility and medical care. Although necessary, it would be all too easy to point blame on prescribing practices and inadequate treatment and prevention without first looking at the existing social disparities.
The coronavirus pandemic has revealed fatal flaws in our for-profit health systems, just as the opiate crisis has unveiled systemic class discrimination and social disparities of healthcare. It remains to be seen how racial issues play out in the government and public health responses to the opioid epidemic, branded as a ‘white problem’, and the pandemic for which ample evidence exists that the novel coronavirus is hitting many communities of color in the U.S. drastically harder than majority white communities. These inconsistencies are not not a result of biological differences but are in fact due to structural racism.
The government worked rapidly to initiate an urgently needed COVID-19 response, meanwhile, Congress and State Legislatures dawdle in addressing the opiate outbreak which has plagued the country’s disadvantaged for years. The intersectional narrative of these two epidemics is sheer proof that in the United States, financial standing and social status, and, often, racial classification, are the deciding factors of one’s quality of life or imminent death. It is of the essence that we raise the standard of care, implement strong safety nets, diversify accessibility, and provide healthy conditions for all communities and the generations to come. This is the moment to take collective action.