Thoughts on the twin epidemics: Opioids and COVID by Dr. Susanne Fogger

Its January already: colder weather and shorter days. More than 20 months since it first sent us on a two-week work from home break, and our unwanted visitor COVID-19 continues to impact our lives.  

The past year and a half have been a challenge for us all. As I work in behavioral health, I think about how prior to COVID-19, the opioid epidemic was the epidemic. COVID has taken center stage in the news and general conversation, but it is important to note the issue with substance use has worsened.

Hidden within the news of COVID-19 and its effect on health and humanity is the opioid epidemic. While the daily COVID death count has captured national attention, the numbers of overdose deaths reversed course from previous years and began to increase. From February 2020 to February 2021, 95,423 people lost their lives due to overdose, with approximately 50 percent of those deaths directly attributed to opioid overdose.

While other states have seen higher rates of opioid use, the state of Alabama has been significantly impacted by the opioid crisis. Alabama’s overdose death rate had risen from 3.9 deaths for every 100,000 people in 1999 prior to the influx of prescription opioids, to a high of 18 per 100,000 in 2017. Prior to COVID, in 2019, the death rate began to fall—reaching 16.3 per 100,000. Statistics for the last year have not been finalized, but figures from March 2021 show in the previous 12 months, more than 1,064 Alabamians lost their lives in overdose deaths—about 21.5 deaths per 100,000. This number also varies per county, with some communities in Alabama more severely impacted.

Yet, the statistics don’t tell the entire story. We cannot only consider use without discussing causes for use and how different factors may impact use. A necessary aspect to consider is the unprecedented role of isolation, an important tool in slowing the spread of the virus. However, isolation negatively impacts people in recovery as well as in active use of opioids. Isolation is a state of being which can lead to loneliness, depression and other feelings that fuel substance use. Many people do not cope well with boredom, anxiety and loneliness without supportive human contact. Isolation and lack of human contact mean the cycle of addiction remains unbroken.  

Isolation for an individual actively using opioids also means there are fewer people around who can provide the lifesaving, opioid overdose reversal agent Naloxone, also known as Narcan. Accidental overdoses can occur if a drug is more powerful than the user realized, or if the substance is altered with a stronger substance, such as fentanyl. This reversal agent can prevent an overdose death and has saved many lives throughout the opioid crisis. In 2018, the number of naloxone treatments administered increased by 37 percent from 2017—nearly 5,000 doses were administered in Alabama alone.

Just as we continue to seek out tools to address the COVID-19 pandemic, we must continue to find tools to mitigate the impact of the opioid epidemic. If you are wondering how you can help, here’s what I recommend:

First: Recognize that opioids as a substance are not evil. The human brain seeks out substances to produce states that may be unattainable without the drug, and we need to have compassion for those dealing with substance use and misuse. This is life no one chooses. Addiction is a brain disease, with addiction impacting individuals from all walks of life. In addition, there is a belief that all those who die from an opioid overdose are addicted to the substance, but this is not true. Some individuals are in recovery and return to too high a dosage, which overwhelms their system and leads to over dose. Others may encounter a drug tampered by a stronger substance. I had the opportunity to consult with an expert on opioids, an individual living substances free and in recovery from a heroin use disorder. For individuals addicted to opioids, he said individuals in possession of the drug would have a singular focus on the drug and the feeling it produced. Nothing else. It may be a challenge to understand this perspective, but it is important to remember as we extend resources to individuals with opioid use disorder.

Second: Find ways you can become more educated on recognizing signs of opioid use and become trained in naloxone administration. There are online resources that enable you to obtain overdose reversal drugs from the pharmacy, or there are local trainings through the Jefferson County Health Department. The online training is simple (less than 15 minutes) and once completed, the JCHD will mail the rescue medication or you can pick it up from a local pharmacy. Carrying naloxone can be part of the nurse’s emergency supplies or kept with an automated external defibrillator (AED). Like all medication for emergency use, we hope we never have to use this, but I have a kit for “just in case.” I recommend everyone complete the training. Much like CPR, you never know when you will need it.

Finally: We must remember that any epidemic, any health challenge, is a team effort. Even for individuals not living with an opioid use disorder, support and community are vital. Nurses like to consider themselves prepared to face any challenge. COVID continues to be a formidable challenge. We too, have been isolated with our ability to remain connected muffled by masks, and social distancing. We know that caring for others requires that we must learn how to care for ourselves. I am not recommending bubble baths or long walks in a forest, although very useful, I advocate for considering a different way to we work. The U.S. Army understood the power of relationships is at the heart of and is the power of small units of people. Working as a team, together they become stronger than single individuals. When one person faltered, that person is provided care close to the battle line, and once the individual recovered, they returned to their team. Given the ongoing stressors related to the opioid and COVIVD epidemics, nurses must work with as a team, including developing a “buddy system.” The relationship is mutual and ongoing. Perhaps a mental health support team to care for our valuable health care providers so they can return to work having been treated close to their team.

Try doing something different, pick a co-worker and let them know you are trying out the “buddy concept.” Are they willing to be checked on and they check in on you for several weeks? Then just notice how you feel in a few weeks. Being connected matters.