Drug addiction and the pandemic: A deadly combination

We are all too aware of the tragic losses we have suffered because of this pandemic. The Center for Disease Control and Prevention (CDC) reports that over 570,000 people have died of Covid-19 as of this writing. What you may not be aware of is another tragic loss of life that occurred at the same time. Over 87,000 individuals overdosed and died in the last 12 months leading to September 2020 according to the CDC. This is a record number of yearly deaths and 29% more than the previous year.

Adams County also experienced a spike. The Coroner’s office has reported 18 deaths in 2020 and only eight in 2019. For explanations of these spikes in deaths, public health officials are zeroing in on the pandemic and a behavioral health service system that failed these individuals. Later we’ll look at whether a Canadian-style single payer system would have been a better service model that could have saved some of these individuals.

The pandemic exposed gaping inequities in our healthcare and economic systems. We know that people of color were more severely affected than others in terms of severity of the disease and lives lost. What we are also learning is that it had a disproportionate effect on those who are addicted to drugs. The combinations of isolation, lockdowns, the lack of access to healthcare services, and the collapse of the substance abuse treatment system created a perfect storm. The result was record overdose deaths. Many of these deaths could have been avoided if our market-based healthcare systems were accessible and coordinated. During the pandemic they were not.

The pandemic created disruptions for everyone. For addicts, drug supplies were disrupted. This created new sources of drugs where potency was unknown. An example was the deadly introduction of an extremely potent synthetic fentanyl imported from China (Economist March 30, 2021). Also, addicts were alone and isolated. Many were in remission but started using again to alleviate the anxiety and loneliness. As a result, many died alone. There was no one to call 911 or to deliver a life-saving dose of naloxone.

The pandemic also brought large-scale unemployment. Most of those unemployed lost their health insurance. COBRA insurance coverage was available to many, but it is often prohibitively expensive. Also, many low-wage workers never had health insurance, and never applied for Medicaid or the Affordable Care Act coverage. For those addicted to drugs, unemployed, possibly homeless, and without insurance, access to substance abuse treatment services was economically impossible.

Just at the time when addicts needed treatment services, those service providers were closing their doors according to an April 2020 report from the American College of Physicians. Substance abuse treatment services include face-to-face communication, one-on-one counseling, support groups, and group therapy. These therapies do not lend themselves to social distancing and mask wearing. As a result, treatment providers were going out of business or were shutting their doors during lockdowns (Recovery Centers of America March 27, 2020). Our healthcare systems are market-based and are subject to competitive forces. So, when profits plummeted, doors closed.

Just as these treatment services were collapsing, cash-strapped states like Oregon, Florida, and Colorado were slashing millions of dollars from their behavioral health and Medicaid budgets according to a STAT daily publication dated July 16, 2020. This put even more financial pressure on treatment providers. The federal government did pass the American Rescue Plan into law in March 2021, but the $3.5 billion provided to behavioral health services was not enough to fill the gap. For many the relief was too little, too late.

Unfortunately, the behavioral healthcare system failed these individuals. Our market-based system with its reliance on profits and competition is not an optimal healthcare model during a public health crisis like the pandemic. Without a steady flow of funds, many of these providers closed their doors. They were forced to abandon their patients just when those people needed them most.

Would a universal healthcare system like Canada’s have done better at reducing overdose deaths? Canada also experienced an increase in opioid deaths which totaled 2,450 from January to September 2020 (Vice World News, September 15, 2020). However, that is well below the U.S. death rate. An August 2020, article in the Journal of the American Medical Association lists some reasons for Canada’s success. Canadians have access to healthcare regardless of their financial status. Also, their healthcare system emphasizes coordination not competition. Canadian treatment providers did not shut down services during the pandemic. Instead, they provided case management and other services even during lockdowns. Also, their healthcare system is not fragmented so there is opportunity for national leadership. While it may be too early for definitive, comparative studies, the Canadian system probably saved lives.

Hopefully our substance abuse treatment services can recover as the pandemic wanes. For those who need services, the Substance Abuse and Mental Health Services treatment hotline number is 1-800-662-4357. It is available 24 hours. Any analyses of America’s actions and responses to the pandemic should include the behavioral health treatment system and the 87,000 individuals who lost their lives due to untreated addiction during a global pandemic. In the next pandemic we need to be better prepared.

Tom Deloe is a Gettysburg resident and a member of Gettysburg Democracy for America’s Healthcare Task Force.