The Connecticut Department of Public Health just released a warning to local public health directors of increased fatalities due to opioid overdoses, based on recent data from the Connecticut Medical Examiner’s Office.
This has been a feared response of public health authorities in the midst of the COVID-109 epidemic. Historical data showed increased substance use in the aftermath of Hurricane Katrina and 911. Depression and post-traumatic stress increased markedly as well as substance us, and while the rates of PTSD and depression eventually dropped, the rates of substance abuse stayed high.1
There are many reasons why substance abuse may increase and be more dangerous during the COVID-19 crisis.
Established drug supply lines are expected to experience disruptions that may force users to buy from unfamiliar sources, increasing their chances of overdosing.
Training and substance outreach programs are either closed or have limited hours. Some have moved on-line, which is okay if you have a home and a computer. Not so much if you are displaced.
People may not have access to the help they need as well as reduced access to naloxone and clean needles.
Isolating people with existing mental health issues may lead former users (with now lowered tolerance) to return to substance use.
The increased release of prisoners with history of drug use puts them at risk for overdose due to their lack of tolerance.
Patients with undiagnosed COVID-19 may be less resilient if they do overdose due to reduced respiratory capacity.
And people without work, with increased economic and social pressures, may seek escape.
Last Friday, I responded for a report of an unconscious person. I arrived first and was let in the apartment building by the superintendent. I find whenever I am sent for a similarly dispatched call and the superintendent meets me at the door and leads him up the stairs and down the hall at an unhurried pace, the result is usually always the same.
The apartment is vacant. No furniture, no boxes, nothing. Freshly painted walls, floors neatly swept.
“In there,” he says, pointing to the room at the end of the hall.
There is a single mattress in the room. A woman with her head on a backpack and a ragged blanket over her is clearly dead. Her head is purple. She is cold to touch with rigor mortis and dependent lividity. After running my six second strip of flat line and calling the time, I look for signs of drug paraphernalia, but I can find nothing. There is a single cup with eight or nine cigarettes smoked to their hubs. No needles, no works, no heroin bags. Nothing to suggest this is a drug overdose. I am guessing she is in her fifties. The police arrive and I hand them the death information, then grab my gear and leave.
On the radio I hear a medic unit that was dispatched for a person unresponsive in a port-o-potty in a park across town clear with a presumption. That port-o-potty is notorious for drug overdoses because it is so close to heart of the drug-dealing on Park Street. I regularly check there for heroin wrappers to see what the latest brands are.
A couple hours later I am driving down Albany Avenue when I see Mark Jenkins sitting on the back of his outreach truck, out in front of his walk-in center which is closed. The center’s hours have been reduced during the outbreak, but he still gets out as much as he can in the van, which has flags on now to make it more recognizable. I pull a U-turn and park in front. He tells me they are upset because they have lost another member of their family. By family he is speaking of the community he serves, the men and women who come by the center or he and his outreach workers talk to on the streets or in their homes, be they apartments, vacant buildings or homeless encampments.
“Are you talking about the guy in the port-o-potty?”
“No,” he says, clearly not following me. He mentions the address where I found the dead woman.
“I was there,” I said. “I didn’t recognize it as an OD.”
Someone must have cleaned the scene, he says. He tells me she was a regular user. They saw her every day at the center. He mentions her by name. I wonder if I have met her. I stop by the center often, but the face of a dead woman and the face of one with a living soul are not the same.
Mark tells me he is worried. Now in this time of COVID we are telling people to isolate, to distance themselves, which is opposed to everything we have told the substance use community in the past. Come together, look out for each other, there is safety in groups.
The battle is all around us.
We are in this together.
1 NIDA. (2005, August 1). Bulletin Board. Retrieved from https://archives.drugabuse.gov/news-events/nida-notes/2005/08/bulletin-board on 2020, April 14