Heroin paraphernalia, image credit to Matthew T Rader, licensed under Creative Commons

Although the COVID pandemic is past its peak, the opioid epidemic across the country is showing no signs of abating, from rural areas to inner cities.

According to the CDC, between the months of June 2019 and May 2020, when the pandemic and the cautions that came with it in its earlier stages led to a major decrease in socialization and leaving the house for most people, over 81,000 drug overdoses were recorded, the highest number to ever take place in a 12-month period. The total number of opioid overdose deaths for the year 2020 was estimated at 68,630, a 44% increase from 2019.

At the Rx Drug Abuse & Heroin Summit in April 2021, the director of the National Institute on Drug Abuse, Dr. Nora Volkow, stated “The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans.” “Dealers are lacing…non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she continued.

There is no question about the seriousness of the issue, but there does remain the question of how it began. John McAteer, former Health Care Associate for the NYC DOHMH in the Bureau of Alcohol and Drug Use, Prevention, Care and Treatment, explains how the epidemic began and culminated into what it is today.

“The biggest issue was the overprescribing of opioids.” In 1995, Dr. James Campbell, in an address to the American Pain Society, declared pain as the “fifth vital sign.” The following year, the opioid OxyContin hit the market, and was heavily advertised on TV commercials, the radio, and eventually the internet, posing itself as “the answer to all of your pain,” and with many Americans suffering from chronic pain disorders, the drug appeared to be a “miracle pill.” However, pharmaceutical companies initially claimed the drug was not habit-forming, which was simply untrue. Due to the way OxyContin is formulated, a tolerance can be built up with continued use, and more of the drug becomes necessary to treat the same level of pain, leading doctors to increase the dosage in addition to overprescribing. As a result, many chronic pain patients became physically dependent on the medication.

“People were actually breaking into pharmacies looking for this medication,” McAteer explained. “And it just really got out of hand, and… [people] were just stuck on it. So, eventually, the national entity that regulates prescriptions started telling doctors ‘look, you cannot prescribe this anymore.’ And some of the doctors were even not going through insurance with some of the medications, they were just selling the prescriptions for cash, right? So they were getting rich off of it as well. So finally…the CDC put a stop to it, says you can’t prescribe anymore, right? And so doctors were just…saying to patients ‘sorry, can’t do it anymore.’ And so now these clients are stuck, and now they’re…starting to physically withdraw, right? So now they’re looking to street heroin, or they’re looking to other substances in order to make them feel better. Heroin was like the number one replacement because it was so cheap.”

Troy Joseph, a sober coach who helps addicts trying to get sober and a former opiate addict, offers his perspective on how COVID has affected the epidemic. “COVID definitely…brought people indoors, first of all. And for a blooming drug addict, one that’s maybe not a drug addict quite yet…it was sped up by the COVID pandemic…a lot of people lost their jobs, and even the people who didn’t lose their jobs, they were working from home, and so I think when people are stuck at home and bored, that’s one way that people start picking up drugs. But I think a lot of it also too is like, a lot of people were scared of what was going on or they didn’t know if they were…gonna get sick, or have their parents get sick…so I think fear also has a big impact on people using drugs. But yeah…during COVID, when I was working…I worked at a sober house, the number of people that were in the sober house grew during that time. And then, the number of house calls and wellness checks that I was doing probably tripled. So, on a normal month before the pandemic…I’d have about four or five wellness checks a month, and during COVID it went up to about fifteen…and I think…there was tons of problems about opioids fifteen years prior, like the way that they were overprescribed, and that’s how I originally got into heroin use was…tons of OxyContin on the market. And then…socially using OxyContin turned into not being able to get OxyContin, and then turning to heroin. But I think COVID, for a lot of people, it just either sped it up, exacerbated it, and made it worse for sure.”

Joseph also described the dangers that came with the introduction of fentanyl. “It’s really dangerous right now. I got sober before fentanyl really hit the market, and within the last year, about 25 people that I’ve either known or worked with or been in meetings with have died…including…literally one last night. So…this person that died was actually trying to take Xanax, and the Xanax was pressed with fentanyl, and it killed him. So…it’s taken a whole new wave of normal, social drug users, and is turning to kill them. I saw an article in the Wall Street Journal yesterday where three business professionals, women, a lawyer, a CEO, and someone else bought cocaine, and it was laced with fentanyl, all three of them died…we’re seeing this very dangerous wave of a drug come through, and…one, I’m very grateful that I’ve gotten sober before all of this, but I think we’re gonna start seeing it get worse before it gets better, especially now that it’s in about five different drugs. So, someone that’s actually looking for fentanyl, doesn’t have to be just that person anymore, it could be someone looking for cocaine, someone could be looking for OxyContin, someone could be looking for Xanax…and ecstasy. So…it makes it really dangerous to be playing out in the market, and to have…test-strips if you are gonna use drugs to test it for fentanyl, because if you don’t take fentanyl on a regular basis…about seven grains of salt can cause an overdose.”

McAteer described how the health department worked to reduce overdose deaths. “So what we did was a three-pronged method…We hired all of these people to go out to every primary care doctor in Staten Island, and then Manhattan and then the outer boroughs, to give them the information that they should only be prescribing for two weeks at a time, they should only be prescribing a certain dosage, and that they shouldn’t be prescribing with these other medications (such as benzodiazepines). So…that was successful, that lowered overdose. What the health department also did was put Naloxone in every pharmacy throughout the city…Naloxone is a kit to prevent overdose. And they were free, you could get them free from the drug stores. So, this way, if I am using heroin or if I’m using something with a friend of mine, and I see that he’s going into an overdose, I can take care of that right then and there, right, and prevent the overdose, call 911. So that was the three-pronged approach, and I would say it was overall successful.”

Many experts agree that there is a solution to this, and that it is a problem that can be solved. Individuals and society itself can take certain steps to prevent the crisis from getting worse.

McAteer also discusses how he believes the situation can be improved. “I think that a good way for us to take care of this situation is continued education of primary care providers and people just in regards to…the dangers of opiate use, I think that that’s helpful…the education of the doctors and the clients or the patients is important. I think the insurance companies need to also start paying for holistic remedies for pain. I think that that would also help…to give clients something else that they could invest in, that insurance companies are willing to pay for, to help them reduce their pain. I think continued education about overdose is super helpful.”

Joseph also mentions a similar sentiment in explaining the most important ways of helping opiate addicts. “The main thing is to create…an awareness of [fentanyl]...telling…my sponsees or the people I meet that…it’s in more drugs. And then when someone wants help…then I go through the precautions and steps of…either taking them to a detox facility, or taking them through a hospital, and then we take them to treatment, and then I would recommend them go to 12-step, see a therapist, take psych meds, take meditation class…you use all the tools that you possibly can because as we know it’s a life-or-death thing out there right now. It’s scary, and…I think awareness and just sharing my experience with drugs usually is the thing that helps people the most.”