- August 31 honors lives lost, raises awareness, and instigates action and discussion about evidence-based prevention and drug policy.
- During the pandemic, it has been difficult for those living with SUD to rebuild meaningful social connections and have hope for the future.
- From November 2019 to October 2020, we saw the highest number of overdose deaths ever recorded in a 12-month period.
- Support groups, governments, companies, and individuals are taking steps to reduce stigma, promote public health, and foster social connection.
International Overdose Awareness Day began in Australia 20 years ago to raise awareness of overdoses, reduce the stigma of drug-related deaths, and remind us of the grief felt by the families and friends of those who have died as a result of substance use disorder (SUD). Today, as the death toll from overdose continues to increase, International Overdose Awareness Day is recognized in more than 40 countries. We pause on August 31 to honor those lost as well as raise awareness and instigate action and discussion about evidence-based prevention and drug policy.
Unfortunately, the arrival of COVID-19 exacerbated an already worsening trend in overdoses and related deaths. The American Medical Association recently released an issue brief on our country’s overdose epidemic, revealing some very concerning data:
- Every state has reported a spike or increase in overdose deaths or other problems during the pandemic.
- The overdose epidemic is now driven by illicit fentanyl, fentanyl analogs, methamphetamine, and cocaine, often in combination or in adulterated forms.
- Overdoses related to prescription opioids and heroin, also increasingly adulterated with illicit fentanyl, remain high.
Opioids were not the only drug leading to increased death during the coronavirus pandemic. Alcohol abuse has also grown substantially in the year-and-a-half that COVID-19 has ravaged the world. The BBC reported these statistics for England and Wales, just during the first nine months of 2020:
- 5,460 alcohol-related deaths, an increase of 16 percent from the same months in 2019.
- The highest death toll attributed to alcohol since records began in 2001.
- Deaths peaked at 12.8 deaths per 100,000 people in the first three months of 2020 and stayed at that level through September, also a record high.
- The rates of male alcohol-specific deaths were twice those of women.
The isolation, fear, anxiety, and grief generated by COVID-19 have contributed to the misuse of substances of all kinds. We also know that for those coping with any form of SUD, consistent support is key. Let us take a closer look at how that support has been altered by COVID-19, before we explore what can be done to reverse the growing overdose trend.
Deprived of Community
For many of us, quarantine and physical distancing have been annoying and tedious; to those who require life-saving medications, healthcare providers, and a social support system to recover from SUD, pandemic-generated restrictions have led to life-and-death situations of a different kind. Provisional data from the Centers for Disease Control and Prevention (CDC) shows that the U.S. saw nearly 92,000 drug overdose deaths from November 2019 to October 2020, the highest number of overdose deaths ever recorded in a 12-month period.
University of Virginia anthropology professor and author Jarrett Zigon recently wrote: “Addiction is often called a disease of loneliness, and during the pandemic, loneliness is something that many more people experienced.” Professor Zigon admits that overdose increases during COVID-19 are not surprising, since it has been so difficult for those living with SUD to rebuild meaningful social connections and have hope for the future.
Ashley Bolton, Pennsylvania’s director of the Office of Drug Surveillance and Misuse Prevention, takes the consequences of coronavirus isolation one step further, “We also have heard from local communities, an increase of individuals using substances alone, so the opportunity to utilize Naloxone may have been lower by a bystander. Also the fear of going to the emergency department, especially early in the pandemic.”
Isolation is not the only factor that has contributed to increased overdose deaths. The National Institute on Drug Abuse points out that public health measures have disrupted the flow of resources such as methadone dispensed from clinics. This increases the risk of relapse, as do stress about employment, money, family, and housing.
In-Person to Virtual: A Shift in Engagement
Those living with addiction endured one significant change in the early days of the pandemic: the suspension of in-person Narcotics Anonymous (NA) and Alcoholics Anonymous (AA) meetings.
Recovering alcoholic Daniel Martin McCormick says, “The switch from in-person to online at the onset of the pandemic was overnight.” He describes the move from the stability and comfort of in-person AA meetings to Zoom, where there were no hugs, handshakes, or after-meeting gatherings at a local coffee shop. There were Zoom bombers, time limits, and the “challenge of staring into a screen.” Some people were uncomfortable meeting online or were unable to do so because they lacked the technology or connectivity.
Yet McCormick’s group worked hard to maintain the 12 steps and 12 traditions of AA even as it met virtually. It welcomed participants from different time zones and a “new type of community.” McCormick also describes how the anonymity of Zoom (with no need to turn on your camera or use your real name), emboldened some who had never attended an AA meeting to take that first step toward recovery.
Narcotics Anonymous also uses the Zoom platform for its virtual meetings. To achieve its mission, “to provide a context where people experiencing addiction can help one another stop using drugs and find a new way to live,” NA created a new website, virtual-NA.org. Today, it offers more than 2,800 online meetings every week, Sunday through Saturday, in a range of languages. These sessions not only support those who formerly went to live meetings but also people in rural settings who found it difficult to be part of an in-person group. Like AA, what were once local NA meetings became national and international. Like many other organizations, NA and AA expect their post-pandemic models to include both in-person and virtual groups.
Actions Aimed at Reversing the Trend
Besides traditional outreach like NA and AA, there are new resources for those at risk of overdose. The Substance Abuse and Mental Health Services Administration (SAMHSA) has created a tip sheet on virtual recovery options for those with substance use and mental disorders. For people in an opioid treatment program, SAMHSA also has issued guidance for states to receive an exception to administer 14 to 28 days of take-home medication. Additionally, the American Society of Addiction Medicine has prepared a Clinical Practice Guideline on Alcohol Withdrawal Management, to especially help patients whose evidence-based treatment may have been limited by the pandemic.
While deficiencies remain in our country, individual states are leading the way in acting on behalf of those living with addiction or in recovery. Rhode Island recently enacted a law that mandates SUD and mental health services provided by organizations such as NA and AA as “essential.” These groups and others may now hold meetings during a declared disaster emergency, because they are deemed necessary for public health.
In addition, Rhode Island has established a two-year pilot program beginning in March 2022 to design, open, and operate the first harm reduction centers in the U.S. Also known as overdose prevention sites or supervised injection facilities, these centers will direct people to treatment for SUDs as well as behavioral and physical health screenings and recovery assistance.
In Pennsylvania, where drug overdose deaths went up nearly 14 percent from 2019 to 2020—and 63 percent among its Black population from 2018 to 2020—officials are dedicated to overcoming the issues compounded by COVID-19 restrictions. Working closely with counties, cities and towns, the Pennsylvania Coordinated Medication-Assisted Treatment program is increasing its overdose prevention and response services throughout the state, with 8,000+ people already receiving PacMAT treatment.
Taking a different tack, Oregon decriminalized possession of small amounts of almost all hard drugs last year. With its rates of drug and alcohol addiction near the top of all states—and almost at the bottom for access to recovery services—it decided to take on SUD with a health model rather than criminalization.
Oregon also aimed to lessen or even eradicate racial and ethnic disparities in convictions and arrests. Without a criminal record, those with SUD should find it easier to get housing, jobs, student loans, and professional licenses. Of course, COVID-19 has made implementation more complex, due to reductions in treatment beds and services. With vocal advocates and detractors, the experiment remains a work in progress.
Individuals Making a Difference, Too
In recognition of World Entrepreneurs’ Day (August 21), I would be remiss in omitting the many creative business people who continue to join in the fight against SUD and overdose. Four years ago, INC Magazine featured eight new companies focused on battling the opioid epidemic. Today, those companies are still at it, taking on addiction treatment and recovery with innovative apps, therapies, and data analysis.
As an entrepreneur myself, I have dedicated my career to improving access to quality substance abuse, mental health, and medical treatment and prevention services. It is a global public health effort, achieved by helping one person at a time, which holds great meaning for me. If you are able to volunteer for organizations assisting those living with addiction or in recovery, please do so. Your efforts will honor both those whom we have lost to overdose and the many we will work together to save.