A few academic studies that have been published recently are confirming some of the concerns I have had since the beginning of the Covid-19 outbreak in the United States. This includes a study from the Journal of Rural Health, and the scientists who conducted the study warn of increased risk of Covid-19 infection and overdose for those people with substance use disorder during a time of quarantine. The Journal of Rural Health is extremely pertinent for the Alabama rehab and recovery industry, as well as the Florida Panhandle rehab and recovery healthcare community. Now I will get into some of the specific concerns that the researchers discussed pertaining to rural people with substance use disorder.
The most basic and first concern is the ability to obtain the basic necessities of life. The researchers phrase it in this way,
“People who use drugs may have difficulty accessing needed shelter/food/drug/equipment and other provisions necessary for sheltering in place for an extended period. Vulnerable populations, including people who use drugs, face barriers when preparing for and responding to crises, including pandemics.”
Note at this point that the phrase, “people who use drugs” is meant to encompass a larger number of people than even my usual phrase of “people with substance use disorders” because people who are not necessarily dependent or addicted to one or more drugs are included in the former. Also, when the researchers refer to people who use drugs, or PWUD, they are mainly referring to rural people, as this journal concentrates on those populations, but these concerns exist in urban and suburban areas for the same reasons in this circumstance. One interesting risk factor mentioned in this section is the ability of PWUD to effectively organize their own personal response to the pandemic and shelter in place orders. Withdrawal syndrome is one of the main threats facing many people with substance use disorder during a shelter in place order because if you have been using opiates every day, as one example, immediately sheltering in place offers the prospect of miserable sickness, emergency room visits, or emergency trips to see a drug dealer or acquaintance who has drugs. All of these scenarios offer the risk of exposure to the viral threat, especially when hospitals are already overcrowded with Covid-19 cases.
That section touches on the larger looming risk associated with drug-seeking during a pandemic in general, and another very scary threat is not as obvious. There is also great risk associated with the fact that people who use drugs may not seek medical treatment because of the stigma they face in medical settings. If a heroin addict has needle marks on their body, they may be less inclined to see a doctor, go to a hospital, or get a blood test for Covid-19, putting themselves and people around them at risk.
The researchers sum up the issue of stigma in this way and note in this quote the fact that the study is referring to actual qualitative evidence of bias and stigma from first responders against people who use drugs.
“Qualitative analyses in our area have discovered substantial bias against PWUD by first responders, and multiple instances of stigmatizing behaviors (e.g. enforced toxicology screens; perceived lack of respect). Even before the pandemic, rural PWUD were less likely to seek medical care (eg, urgent care, paramedics) and actively avoid others (e.g. the police) who are now especially prominent in the COVID‐19 response.”
Anyone in the United States right now, during Covid-19, would have to agree that first responders, police, fire, and medical personnel, are playing a huge role in keeping people safe. But for decades some people in these same fields have shown intense bias towards people with addiction, and in many cases, people with substance use disorder are mistreated and disrespected by first responders. I would not have been able to make this point myself, but the data suggests that this is the case. The areas that the researchers were studying were rural areas, so people in Alabama rehab and recovery should know that avoidance of first responders can be a concern, and it has a basis in the data. If you are a person that needs substance abuse treatment during Covid-19, we have already seen many facilities that were forced to close during Covid-19, but I work for a facility in Panama City, Florida called Florida Springs Wellness and Recovery Center, and they do have space for people that need help, whether they are coming from an Alabama rehab that has closed, or simply live in Alabama in the proximity of the Florida Panhandle. You can get more information on the programs page on this website.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
“Covid-19 during the Opioid Epidemic.” The Journal of Rural Health. First published: 11 April 2020 https://doi.org/10.1111/jrh.12442