Has America forgotten the opioid epidemic?

Numbers build stories. So let’s talk about numbers that haven’t gotten the attention they should. In just the first three months of 2020, 19,416 people across the country died from drug overdoses, surpassing last year’s first-quarter total by almost 3,000, according to the U.S. Centers for Disease Control and Prevention. From April 2019 to April 2020, rural states such as South Dakota, Wyoming, Mississippi, and Iowa saw overdose deaths increase by more than 30%, while the District of Columbia saw a 54% increase. 

The media storm that used to engulf America’s opioid epidemic has dwindled, as COVID-19 consumes our attention. Government leaders seemed to have forgotten about addiction too. Meanwhile, the coronavirus pandemic has intensified the economic stresses and social dislocation that can spur substance misuse and cut off people in recovery from the support they desperately need.

“We have lost so many people to overdoses since the pandemic started,” said Brooke Parker, a community organizer with SOAR — Solutions Oriented Addiction Response — in Charleston, West Virginia. “Just because it's so isolating. (It) is really hard to stay sober by yourself.”

In 2017, President Trump declared the opioid crisis to be a public health emergency. He made no promises of delivering additional funding and no mention of stopping the supply of deadly synthetic opioids supply such as fentanyl. He did commit to the government producing “really tough, really big, really great advertising” to persuade people not to misuse opioids. 

In West Virginia, which has been hit harder by the opioid crisis than just about anywhere else, there is no time for pretty billboards and lip service. The state is one of more than 40 that have seen an increase in fatal opioid overdoses since the pandemic began. West Virginia counties have reported spikes in emergency calls for overdoses. 

The state government has taken several steps to support people in recovery and protect those who misuse opioids. West Virginia expanded Medicaid and the state has a standing order that allows residents to get Naloxone without a prescription to reverse overdoses. In August, the West Virginia Department of Health and Human Resources announced it was receiving $43.7 million in federal funding to strengthen opioid-fighting efforts. This was a positive move but came late as a response to a deadly crisis.

In March 2018, Kanawha County, which has one of the highest number of overdoses in the state, temporarily suspended syringe exchange programs because of concerns that they caused more crime. No data supports this theory, and health experts, including the CDC, have lauded syringe exchanges as one of the most effective ways to prevent the spread of infection and keep users safe until they are ready for recovery. As the coronavirus pandemic took off, state lawmakers proposed to ban the practice altogether, but the bill died.

If you want to understand the addiction challenges right now, ask people working on the front lines, such as Brooke Parker of SOAR. The group has been providing users with food, personal protective equipment, contacts for counseling, and “safer kits,” which include clean syringes.

Parker says the community was struggling and hard to reach before COVID-19. As of mid-November, Charleston had 4,500 confirmed cases of the disease and 133 deaths. Unemployment is high, and many residents have no health insurance. The pandemic exacerbates the challenges facing low-income people dealing with addiction, and the opioid problem complicates the challenges of addressing the pandemic.

“People are so amazingly isolated here,” Parker said. “They need really basic resources like food and housing and clothing. Most people here live in rural communities, which are food deserts. The pandemic has made it so hard to access services that we should have readily available. And when you're homeless and you're hungry and your very basic needs aren't met, I really don't think it's sustainable to stay in sobriety.” 

Parker says people who have been sober for years have relapsed without access to support groups and treatment for mental health conditions. “When you work so hard to pull yourself out of that and build a community that you can stay connected to and feel useful, just to get shoved back into total isolation — it’s been so incredibly difficult.”

It’s not yet clear how the Biden administration will address the opioid crisis while the nation is gripped by COVID-19 and recession. Biden is no stranger to the perils of drug use. His son, Hunter, has struggled with addiction, which Trump mocked during the first presidential debate. Biden stood up for his son and expressed compassion and respect for Hunter’s battle. But it’s hard to know whether the addiction crisis will get the attention and funding it needs.

The selection of Vivek Murthy to be surgeon general is a good sign. In his previous stint as surgeon general, Murthy wrote a landmark report that described addiction as a disease and called for an aggressive public health response. Treating addiction as a health issue instead of a crime could not only ease the problem, but also alter the face of our criminal justice system.

States are slowly moving in that direction and rethinking punitive drug policies. In November, Oregon voters approved the nation’s first measure to decriminalize all personal drug possession. New Jersey, Arizona, and South Dakota are some of the most recent states to legalize recreational marijuana possession. If the Affordable Care Act, which provides coverage for addiction treatment, survives the latest challenge in the Supreme Court, we could see real progress. 

Meanwhile, support groups are the lifeline for many people in recovery. Communication has moved online during the pandemic, but not everyone can simply click their way into resources. 

“Support group meetings over Zoom require a certain amount of privilege,” Parker said. You gotta have the internet. You have to have a quiet, private place to talk. You gotta have a device that's fully charged. That's just not something people always have access to, especially when you’re homeless. It's not something that you pull yourself up by your bootstraps to get over. The bootstraps are broken."