COVID-19 and Social implications of Illegal Drug Use for Persons with Substance Abuse Disorder

Prevalence of substance use disorders

Drug addiction statistics

  • Between 1999 and 2020 nearly one million American citizens suffered fatal opioid overdoses
  • In 2017 alone, 70,237 deaths from opioid overdose occurred
  • In 2017 about 130 people died from overdose each day and these numbers have gotten even more alarming in 2020-2021
  • Since 1999 deaths from drug overdose multiplied by a factor of 6
  • The Opioid Epidemic and COVID 19 pandemics have been declared national emergencies.

The confluence of Substance Use Disorder and coronavirus, drug treatment

Q: What is the intersection of the COVID-19 pandemic and substance use disorder?
A: Due to the COVID-19 pandemic, lockdown measures have been introduced in various countries. Travel has been restricted and this has separated loved ones who sometimes can’t get back to their homes to be with their families. Grade schools, high schools, and colleges have been shut down such that many students don’t get to see their friends, and some poorer students who rely on school breakfast and school lunch may have less food, although many programs have been created in the United States and elsewhere to make sure these students get food supplies.

Older persons may be separated from loved ones who don’t want to risk spreading the virus to persons whose immune systems are less capable of defending against it. However, the lack of close contact and affection itself, makes people more vulnerable to anxiety and depression. This can have the effect of making people more susceptible to substance abuse and viral infection.

People who used to have just one or two drinks with friends may begin drinking alone. People who used to use their medication responsibly and only indulge infrequently may begin abusing their own medication or the medication of others to deal with the loneliness and depression that result from no longer having the normal, close, social interaction with friends and loved ones.

During the COVID-19 pandemic, rates of drug use, especially heroin, fentanyl, and alcohol have gone up compared with previous years and trends from previous decades.

At the same time, the opioid epidemic which started in the late 1990s and early 2000s helped pave the way for hand-to-hand to nose transmission of drugs, pathways along which pathogens like COVID-19 can travel. This creates a powder keg of pandemic viral disease and drug abuse disease epidemics which reinforce each other.

Drug Treatment

Drug treatment can be difficult to get during the pandemic but facilities are still open and they want to be open because they want to make money. Due to social distancing rules, group therapy can be different, awkward, or canceled.

We asked someone who has experienced group therapy in this new environment and they described it as follows:

“In the day program, the group was held in a large room.  Masks were optional for patients, but it was mandatory for employees. Sanitizing not social distancing protocol was followed.”

Drug treatment may also be available online. You can get started by texting a free counselor at  741-741 to Text With a Crisis Counselor.[1]

Or you can call the US emergency mental health and substance use services hotline at: 1-800-662-HELP (4357).[2]

In summary:

  • Drug use causes coordination of smuggling routes for drugs like fentanyl from China, to Mexico, and into the US and often up the noses and into the lungs of users, and viruses including COVID-19 can use these same routes to infect people. Also, opioids in particular cause respiratory depression which can lead to a greater susceptibility of having lung complications when infected with COVID-19 or other flu and cold viruses.
  • COVID-19 lockdowns can cause loneliness which can lead to a lack of endogenous opioids/endorphins, making people more susceptible to trying to plug those endorphin receptors with opioid drugs or alcohol.
  • Drug treatment can be complicated by COVID-19 restrictions but is still widely available anonymously so reach out and get help if you need it.

The relationship between the coronavirus, drugs, news

News is a very important factor in disseminating information about the pandemic. It can have positive and negative effects.

Early on in January 2020, China and the Who used news networks and propaganda to tell the public that COVID-19 was not a threat and not transmissible person to person. This allowed the virus to spread all over the world.

At this point, the Trump administration used press briefings to tell Americans COVID-19 was not a threat and that they should not go out and get masks. As this news spread, it caused the virus to spread faster due to the fact that it was very contagious and we learned that masks were essential to halting the spread.

News networks like Fox then spread propaganda allowing people to think the virus was a hoax created by Democrats. This allowed the virus to spread further, especially among conservative Trump followers. The increased deaths in this group could easily have cost Trump the votes that may have kept him in office or at least legitimized recount efforts.

Effect of COVID-19 on news and vice versa

At the same time, coronavirus affects the news. News staffers are often working from home during the lockdown. People may look different due to not having to make up staff while reporting from home. At least one famous reporter accidentally masturbated on a conference call and was fired.[3]

There have been reports that domestic violence and child abuse rates may have increased during lockdown but it is harder to get accurate figures due to lockdown restrictions stifling in-the-field information gathering and dissemination.

News reports the stats on coronavirus and lets the public know which lockdown restrictions are in effect so the news is always a big player in the pandemic and is also affected by the pandemic. News media is tasked with informing people of which restrictions are in place, which vaccines and treatments are being produced, and what groups will get the vaccines, what order this will be in, and finally, side effects of the vaccines, halting the use of vaccines which cause reactions that need to be investigated, and if the pandemic is slowing down, speeding up, or mutating into something more or less dangerous.  News can hurt or heal the virus pandemic.

Current news as of March 2021 is insufficiently focused on the drug epidemic due to the pandemic, race politics, and mass shootings which grab the headlines. Greater elucidation by the news media of the acceleration of the drug crisis could save lives. By disseminating false information and bad advice early in the pandemic, the media helped to accelerate the pandemic.

3.    COVID-19 Impact on Economic Health, and the social effects of drug abuse during the pandemic

COVID-19 causes a respiratory illness that can lead to many missed days of work. The vaccine can also rarely cause an immune response featuring symptoms like fever and nausea which can also lead to a day or two of missing work. Finally, the lockdown causes many non-essential jobs to be either paused or shuttered and countless industries have suffered significant losses. Many Americans and businesses have suffered financially and the economy has struggled under the weight of the twin pandemics.

The economic crisis may lead to a depressed mood which can raise a population’s susceptibility to substance abuse and illness. Drug abuse can then lead to loss of jobs, strained family relationships, greater proportions of the population imprisoned, more children in the foster care system, children receiving less quality education, and children being traumatized by the overdose deaths of parents and family members. This can set us up for the generational failure of the affected populations. Anger over these challenges can lead to political instability as we have seen in the heightening of protests and riots during 2020 and the attempted coup in the United States at the beginning of 2021.

Unemployment, Substance Use, and Mental Health Comorbidity

Unemployment is significantly associated with substance abuse according to data published in BMC Psychiatry.[4] The causal chain likely goes both ways. Unemployment leads to substance abuse and also substance abuse is the cause of poor work performance and layoffs. During the pandemic, the unemployment rate peaked at the highest levels since records have been kept.[5] This leads not only to drug abuse but other mental health challenges such as anxiety, depression, bipolar depression and mania, and psychotic reactions to stress in individuals with and without chronic psychotic disorders.

Grieving and lonely: the Effects of the COVID-19 Pandemic

Due to the spike in death rates from the pandemic and the opioid epidemic, many families are suddenly without their loved ones, sometimes multiple loved ones. Grieving may last for an extended period and with the newly added stresses are more likely to transition into a chronic depression where more people would have recovered during better times.

Also, the elderly especially may be left lonely due to restrictions designed to prevent them from catching the virus. Students who are suddenly in lockdown from schools may miss their peers and miss important milestones of socialization.

Substance abuse and Addiction Care Practice During the COVID-19 Pandemic

During the beginning of the pandemic, very likely people with opioid and benzodiazepine prescriptions were cut off and suddenly had to get through withdrawals but the world was in such dire straits, there was not much reporting on it. Also, due to the threat of being sued as big pharma companies had, doctors and hospitals were all too ready to let go of these risky lingering prescriptions they have had. Unfortunately, the sudden withdrawal of such medications can lead to mild to serious brain damage, as tapering is essential. But, we somehow made it through that and some people made it to the mental health services which are still operating.

Some of these practices have new social distancing and sanitation rules. As the pandemic has dragged on, many or most have opened back up and are learning to function under the new realities. Group therapy is a foundational part of most substance abuse treatment programs. Participants may be required to wear masks and social distance. More therapy may also be delivered online than occurred before the pandemic.

Alternative therapies for opioid abuse disorder include kratom (mitragyna speciosa) replacement and mitragyna hirsuta (kratom-lite) replacement.

Preventing Drug Abuse During the Pandemic

Firstly, strategies need to be put in place in the United States to decriminalize drug abuse, which is classified as a mental health condition in the DSM-V. States like Oregon have taken the lead, decriminalizing personal use and possession of most drugs.[6] This is the first step to stopping the cycle of drug abuse, a trauma in the family due to overdose or imprisonment of the parent, stress on the child, then drug use in the offspring to self-medicate the trauma. The founding fathers made it clear that unreasonable search and seizure of substances such as hemp which many of them were growing cannot be made legal, therefore all such laws are unconstitutional. The War on Drugs was invented as a way to infiltrate minority groups, as admitted by the architects of the law under President Nixon, who resigned in disgrace due to the runaway criminal activities in which he was engaged.

Next, funds need to be made available for scientists to honestly study how to stop addiction in humans and animals. Alternative therapies like kratom for opioid addiction should be studied and made available for people, rather than pushing very addictive substances like methadone just because it is legal. Methadone is one of the hardest opioids to discontinue, and combined with benzodiazepines, is also a drug of abuse. Our actions need to be based on real science and experience, not profiteering and politics.

We must evolve safe ways for people to interact and be part of a community to prevent loneliness and alienation from others which is one of the largest factors in susceptibility to drug addiction. In animal studies, animals deprived of affection and isolated were at the greatest risk of compulsive self-administration of drugs. The so-called Rat Park experiment showed that in enriched environments, animals will often choose regular food and water over drugs of abuse when a rewarding and stimulating environment was available. But in stressed environments, animals will self-administer drugs even till they die of overdose or starvation.

One way to enrich environments is to encourage “At home but outside” play during lockdowns. During lockdowns, many people and even some cities, states, and countries get the incorrect impression that at-home means inside the house. This is a recipe for disaster. Viral particles are concentrated in enclosures, especially with bad ventilation. Outside treatment for flu pandemics has been used in the past as they noticed people recovered better outside but in a controlled environment. The reason for this is that sunlight improves immune function by producing vitamin D in the skin, but mostly it’s because viral particles disperse through the atmosphere rather than being concentrated and re-inhaled by the one expelling the particles or another person who may then get infected. This often actually happens without either person developing symptoms and these people can then take the virus to more vulnerable people.

People can connect online by using the Watch Party feature of services like Prime Video. This allows you to watch a movie at the same time as a loved one in another location so you can experience the same thing they are experiencing and see their reactions to it.

it’s important to reach out to family and friends who may be lonely and using drugs or alcohol to pass the time.

Recommendations for health services for people in treatment for drug use disorders

People in treatment for acute drug abuse will likely have a period of detoxing. This is when the drug is just getting out of the system. Drugs with serious or life-threatening withdrawals such as alcohol, benzodiazepines, and methadone may require an inpatient medical detox which may include either tapering or a replacement drug to prevent the brain damage and severe fear and pain which can come with withdrawals.

After that period, doctors will assess the patient’s health, taking labs to see if liver, kidney, or heart function has sustained any lasting damage. The patient may then transition to inpatient or outpatient one-on-one psychotherapy, with or without supportive medications to prevent cravings. Finally, the patient may leave inpatient therapy and join groups like AA or Narcotics Anonymous to keep in touch with others in recovery and stay on the right path due to the social support system they have available.

Frequently Asked Questions

Q: Is it true cocaine kills coronavirus?
A: According to the French government and other authorities, a rumor circulated online that cocaine can kill coronavirus.[7] It turns out that this has likely not been studied so no one knows but it’s fair to assume snorting any kind of powder that has been all over the world traded hand to hand is likely to increase one’s risk of any respiratory illness including COVID-19.

Q: Is it true can weed kills coronavirus?
A: It is hopeful that cannabis can reduce some of the inflammation associated with serious COVID-19. Initial impressions appear promising.[8] Forbes magazine has reported that cannabis may reduce lung inflammation in COVID-19 and other cases of flu.[9]

Q: What is the deal with vaping and coronavirus?
A: Vaping may be a means where coronavirus particles may be delivered directly into your lungs, especially if someone else has used your vape pen. Before the coronavirus epidemic, there was suddenly a surge of young people getting heavy lung damage from vape pens. Some theorize the pens were already infected with coronavirus but there is no evidence of this. Scientists believe vitamin E included in some formulations may have simply clumped up in the lungs due to its oil-like consistency. In any case, vaping during the pandemic is not advisable if one can help it, as putting anything to the face, into the mouth and lungs, other than food down the throat, raises the chances you may transfer viral particles into your lungs.

Conclusion

COVID-19 and the opioid epidemic are twin challenges that are dual causes and effects of each other. We can face these challenges by using science-based approaches and letting go of the guilt and blame about drug addiction and how the virus started and spread so that we can focus on solutions for a better world.

Bibliography

  1. “Crisis Text Line | Text HOME To 741741 free, 24/7 Crisis Counseling.” https://www.crisistextline.org/. Accessed 23 Mar. 2021.
  2. “SAMHSA’s National Helpline – 1-800-662-HELP (4357) | SAMHSA.” 28 Jan. 2021, https://www.samhsa.gov/find-help/national-helpline. Accessed 23 Mar. 2021.
  3. “Journalist fired for masturbating in front of colleagues on Zoom – Metro.” 12 Nov. 2020, https://metro.co.uk/2020/11/12/journalist-who-masturbated-in-front-of-colleagues-on-zoom-fired-13583938/. Accessed 26 Mar. 2021.
  4. “Unemployment rate, opioids misuse and other … – BMC Psychiatry.” 10 Jan. 2021, https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02981-7. Accessed 25 Mar. 2021.
  5.  “Oregon 1st state to decriminalize possession of drugs – AP News.” 1 Feb. 2021, https://apnews.com/article/oregon-decriminalize-drug-possession-6843f93c3d55212e0ffbdd8b93be9196. Accessed 25 Mar. 2021.
  6. “Coronavirus: Cocaine cure myth spreads, rebutted by French ….” 9 Mar. 2020, https://www.businessinsider.com/coronavirus-cocaine-cure-fake-spreads-rebutted-by-french-government-2020-3. Accessed 25 Mar. 2021.
  7. “Medicinal cannabis may play a significant role during COVID-19.” 1 Oct. 2020, https://www.healtheuropa.eu/medicinal-cannabis-may-play-a-significant-role-during-covid-19/103093/. Accessed 25 Mar. 2021.
  8. “Cannabis May Reduce Deadly COVID-19 Lung Inflammation ….” 6 Jul. 2020, https://www.forbes.com/sites/emilyearlenbaugh/2020/07/06/cannabis-may-reduce-deadly-covid-19-lung-inflammation-researchers-explain-why/. Accessed 25 Mar. 2021.
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