Of the many people who are particularly vulnerable in this pandemic, the people who have gone mostly undiscussed are those battling drug addiction. From alcohol to heroin, most will mitigate their use with the everyday of life: caring for our children, working, paying bills, engaging in community events. The most recent data suggest that 60% of Americans have used illicit substances at least once in the last year. The overwhelming majority—80 to 90%—will never develop a problematic relationship with drugs. But 10 to 20% of those who use will develop addiction disorder, the reasons for which have been widely and wildly misstated. And those misstatements from our political, faith and community leaders, have resulted in harms that outpace the risks associated with drug use.
Elias Dakwar, M.D., an Associate Professor of Psychiatry at Columbia University College of Physicians and Surgeons, whose research on substance use and addictive disorders has been supported for more than a decade by the National Institutes of Health, asserts that, “People have a harder time maintaining a healthy relationship to substances when stress levels are increased and when there’s greater difficulty accessing resources that allow us to live healthy, meaningful, and happy lives. Social isolation and fragmentation are factors. The relevance of these things to COVID-19 is clear. People are being isolated, finances are disrupted, panic is in the air, family members or friends might be dying, and all these increase anxiety, stress—and vulnerability.”
And, based on all available data, he refutes the two popular narratives about people who use drugs. “One tells us they are intentionally engaging in self-destructive behavior,” Dakwar said. “The other argues that people are addicted because their brains have been taken over and will need to be fixed before they can function like regular members of society again. No data support either theory.”
Dr. Carl Hart, the renowned neuroscientist and author of the forthcoming, Drug Use for Grownups (Penguin January, 2021), concurs. The Columbia University Ziff Professor of Psychology and the immediate past chair of the university’s Department of Psychology has led the world in not only understanding drug use and drug misuse, but the role that racism plays in how we respond to both. In his 2013 award-winning work, High Price: A Neuroscientist’s Journey of Self-Discovery That Challenges Everything You Know About Drugs and Society, Hart explains that if addiction is defined as a behavior that repeatedly disrupts a person’s psychosocial functioning–working or family responsibilities for example–understanding it and treating it is made ever more complex when you account for the ways in which these activities may already be disrupted by larger social realities. Addiction, the scholar argues, is less the problem than the consequences of addiction are. For example, a person who uses substances and can work from home because they may have overused the night before, will not be treated in the same way a person who engages in exactly the same behavior but is fired for missing a day of work. The person who has the privilege of working from home is provided latitude and remains in their station in life, while the other becomes marginalized and put more in harm’s way.
More, Hart explains, discussions about treating addiction cannot be divorced from the role that trauma plays in people’s lives, particularly African Americans who have lived with structurally enforced trauma for centuries—with virtually no structural interventions. We’ve often decried the “drugs that were dropped into our communities,” when we should have focused on what had never been put in—and what and who had been taken out. Legally and socially entrenched discrimination in economic, criminal justice, educational, health and family policy have created a landscape that has ensured not just seeding of trauma, but its growth. That some of us not only survive, but thrive in the presence of these relentless assaults is testament to our strength, creativity and brilliance. But it doesn’t erase the brutality or the responsibility of those who initiate and perpetuate them. And it surely doesn’t mean that our response to those who are, in different ways and to different extents, undone by the brutality, should be responded to other than with the accepted ways to treat survivors of trauma: with proper medical and other healing protocols.
As ESSENCE reported—and now with the world reporting it—African Americans are disproportionately dying of COVID-19. If, as Minister Malcolm instructed, history is best qualified to reward our research, here’s what we can easily predict. Our communities, already profoundly harmed by discrimination in everything from access to healthcare to access to work that pays a livable wage, will not come back from this pandemic in the same time or with the same strength as other communities. Hell, we haven’t gotten the resources–financial and otherwise–to come all the back from slavery. And for the most marginalized in our communities—people for whom jobs won’t be held for, people who have lost their singular, significant family tie, people who are still managing the trauma of having spent years in solitary confinement, only to come home to it—social distancing can a slippery slope toward social isolation.
“People want their drugs,” Dakwar tells ESSENCE, “for the same reasons any of us want anything in life: to feel better. Why they go that route as opposed to another boils down not to a broken brain but to relationships, commitments, opportunities, resources, stress and well-being. These are things we can support and that impact problematic drug use.”
In the Q&A below, Dakwar discusses what we can demand right now, which should be our goal, to help ensure the lives of our loved ones who are living with addiction, especially during this pandemic when support groups and meetings are not readily available.
ESSENCE: With everything happening, why is it particularly urgent for us to think about drug use and addiction right now?
Dakwar: With 65,000 drug-related deaths annually and 40,000 driven by opioid use, we are still deep in the throes of an opioid-driven, overdose crisis. With prescription opioids being less available due to tighter regulation over the past several years, people have been turning to heroin, which is often cut with fentanyl, a more potent, synthetic opioid. Many overdose deaths can be traced back to people taking it unknowingly. With borders closing to contain the virus, heroin, which is imported, will become more scarce–which means people will use what they can find. This will lead to an even greater rise in overdose deaths unless something is done about these issues of supply and demand.
ESSENCE: How does this specifically intersect with the COVID-19 pandemic?
Dakwar: Treating people for an overdose requires us to use the same equipment we use to treat people who become ill with COVID-19: ICU beds and respirators. Opioid addiction is not going to take a rest simply because the eyes of the nation are geared towards COVID deaths. We need to be prepared for the massive onslaught of both types of patients.
ESSENCE: That seems to potentially create a terrible, slippery slope about whose life matters more.
Dakwar: Yes. We have to be on guard about the risks that jeopardize just and equitable medical care.
We already saw in Italy what happens when a great number of COVID patients are vying for the same medical resources. Protocols emerged to designate who is deserving and who is not. In the U.S., which is compromised by deep socioeconomic disparities, the possibility of their influence over life-or-death decision-making is alarmingly high. Do we give a ventilator to a young Black man found on the street overdosed on heroin, or to an elderly white woman whose children brought her in with COVID-related respiratory problems?
ESSENCE: What protocols that would save lives should we be advocating for right now?
1.) Safe-using sites for drug users would avert the incidence of overdose because professionals would be present and able to provide them with naloxone, which reverses the effects of an overdose.
2.) Mobile units that dispense buprenorphine–a semi-synthetic opioid that alleviates cravings and withdrawal symptoms without activating opioid receptors the way heroin does–could be rolled out quickly. Buprenorphine is extremely effective in treating people who struggle with heroin use–and the possibility of overdosing from it is minimal. It also protects people from overdosing on other opioids while they are on it.
3.) Drug-checking kits for people who use drugs like MDMA and cocaine, which can also be cut with substances that cause overdose should be readily available. People seeking MDMA and cocaine typically don’t feel the same sort of urgency as people who are addicted to heroin so drug-checking would be very effective in keeping our family and friends safe and alive.
History tells us how we have been forced to reckon with both our loud shaming of people who use drugs and our stunning silence when the trucks came for our family members in the 1980s and 1990s who were crack-involved. Twenty years on, we are scrambling to undo the harms borne of locking up our mothers, father, friends, brothers, sisters, and children. We’re only recently trying to mitigate the losses at the ballot box, and calculate how mass incarceration and death further entrenched poverty. But what is also true is that here at the outset of the pandemic, we have an opportunity to stand in the gap for our family and friends most at risk by making the choices to lean into science and compassion for people who are living with addiction. We can educate ourselves by using credible, evidence-based work about drug use and misuse. We can choose to value everyone in our community.
We can choose life in the time of COVID-19.
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