A Pandemic Within a Pandemic

The public needs to be aware of the deleterious effects of SUD on COVID-19 prognosis. I am a primary care doctor who has recovered from addiction. These two experiences offer me a perspective of how these two epidemics — COVID-19 and opioid addiction — can impact and worsen each other. Two great epidemics of our generation are intersecting in ways that are additively deadly, and which highlight the urgent ways we must respond to some of the underlying fault lines in our society that are worsening both crises

2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized communities, particularly those with substance use disorders, are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden.

Social determinants of health

People who suffer from the disease of addiction are particularly vulnerable to both catching the coronavirus and having a more severe disease when they do catch it. There are many reasons for this, but they boil down to something called social determinants of health, which according to the CDC are “conditions in the places where people live, learn, work, and play [which] affect a wide range of health risks and outcomes.” 

In short, people suffering from addiction are vastly more vulnerable to coronavirus, as they are more likely to be homeless, poor, smokers with lung or cardiovascular disease, under- or uninsured, or have experienced serious health and socioeconomic issues from drug addiction. There are also millions of vulnerable incarcerated people, many of whom are stuck in jail due to their addictions and related nonviolent drug offenses.

For someone struggling with addiction, virtually all of the services and treatments available to them have been disrupted by the COVID-19 epidemic. People are told to stay home, which directly contradicts the need to go to clinics to obtain methadone or other medications for treating addiction. 

A common truism in recovery culture is that “addiction is a disease of isolation,” so it stands to reason that social distancing — in every possible way — is counter to most efforts to engage in a recovery community. It is important to remember to distinguish between physical distancing and social distancing, and actually emphasize that we keep physical distance, but make extra efforts to maintain social bonds during this time of enormous stress and dislocation.

The social isolation that is so critical to preventing the spread of coronavirus prevents people from attending peer-support groups, which are such a vital source of emotional and spiritual support to people struggling to stay in recovery.

Heightened anxiety is a near-universal trigger for drug use, and it is difficult to think of a more stressful event — for all of us — than this pandemic. Users who adopted harm reduction techniques and had been using drugs with a friend are now using them alone, and there is no one nearby who could administer naloxone or call 911 in the event of an overdose. As a consequence, there have been an increased number of overdoses. When people do call for, the health care system is oft overloaded, and first responders may arrive more slowly. We know that starting addiction treatment in the ED can help prevent relapse, but right now emergency room doctors are absolutely overwhelmed with COVID-19 cases, and might not have the time or resources available to start addiction medications following an overdose

What we need to do now is reach out more than ever to those who are struggling with addiction, and provide them with the resources, such as online meetings, so that they are not alone and forgotten during this dual crisis of coronavirus and addiction. We need to make sure that they are getting the medications they need to recover, that they have access to clean needles if they are still using, adequate medical care, food, and housing — basic human needs.

If any good has come out of the misery of the combined COVID-19 and opioid epidemics, perhaps it is that a clear, bright light has been shined on the deadly social fissures — poverty, income inequality, lack of health insurance and access to healthcare, homelessness — that are the true social determinants of health we will need to address as part of an effective response to future pandemics.

Addiction is a chronic disease. It can be prevented, and it can be treated. It is critical that we do not forget about the nation’s addiction crisis in our response to COVID-19, and instead build a comprehensive approach that will prevent the spread of addiction and ensure access to treatment for all those in need.  

At a systems level, reform is needed to ensure every American has access to treatment for substance use disorders, and that psychological support is widely available not just in times of crisis, but all the time.

At a personal level, we must be vigilant to the struggles of those around us—mental, physical, emotional, economic. Addicts do not have a monopoly on struggling. Everyone is struggling in their own way and we may be physically distant from each other, but we certainly are not struggling alone. Check in on your friends, family, co-workers and neighbors. We must work even harder to build community in times of COVID-19 containment. 

Stay safe and healthy. 

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