Guest Editorial: Now we have two

CRISES, that is. The Coronavirus Pandemic, COVID-19, with its worldwide spread of respiratory disease, has blanketed nearly all of the media outlets of the world. However, a more familiar crisis, the Opioid epidemic, continues to take lives in excess of what most people want to hear or think about. COVID-19 has not slowed down opioid addiction and deaths.  No one hears much about opioid deaths nowadays, yet it continues unabated, since we are absorbed in trying to control the COVID-19 pandemic.

Indeed, we have two serious health catastrophes going on at the same time; has anyone wondered just how each might affect the other? Do we have the resources to control both as they ravage our communities? Do we have plans in place to optimize treatment and control? Is there public support and proper planning to maximize our resources and planning for two serious threats to our citizens? No question about it, the COVID-19 pandemic is having an adverse effect on treatment of drug addiction across the hospitals of the nation.

Effective planning to control COVID-19 infections is ongoing across the world.  There is little such planning for the Opioid crisis. True, many groups – government agencies, private individuals, charitable organizations, etc., have shouldered much of the load to address this problem of addiction and drug abuse. But, compared to the worldwide efforts with COVID-19, the Opioid Crisis is still uncoordinated, misunderstood, with a lack of proper facilities to treat addiction, and a lack of funds to operate them. This is the tragedy waiting to get worse.

The biggest problem that affects individuals, who, for whatever reason, end up overdosing on opioids, is respiratory failure. NARCAN, given early enough to prevent death, may be curative, except when the drugs in the individual are not completely neutralized by the dose of Narcan. That can happen when the amount of drugs circulating is high, or when that drug is one of the longer-acting products; something we are seeing more of as the crisis continues. 

In those cases, after Narcan wears off, the patient re-narcotizes and falls back into respiratory failure. And, what is lifesaving to treat these overdoses? You guessed it: RESPIRATOR/VENTILATORS.  These wonderful machines are lifesaving, as they breathe for the patient unable to do so, until the drugs have worn off enough for them to breath on their own. Overdose victims require hospitalization, beds, and ventilators / respirators. All now scarce.

We have a shortage of hospital beds AND a shortage of respirators / ventilators, projected to be in huge numbers due to the Coronavirus pandemic, and we have opioid overdose patients needing the same beds and equipment as the COVID-19 patients. The shortage is worsening. 

How do we, as a people, decide who gets the lifesaving equipment? We have never had to make such decisions before. And, why is it that our population has been mobilized so quickly in the face of this new virus, but has yet to effectively mobilize in any organized way: make plans, projections, prepare facilities, identify funding streams for the Addiction Crisis, which has been going on far longer than the COVID-19 pandemic?  

One person has speculated, “Because the masses aren’t afraid of becoming affected by someone else’s addiction. However, they are afraid of catching the virus.” 

Another person suggested, “We need to change the way people view substance abuse. People are caught up in a stigma of thinking people who use drugs are ‘bad’ people.” 

And, yet another, “True stigma is the killer shaming our loved ones to not asking for help.”

If we can organize to get rid of this new pandemic virus, we surely should be able to do the same for the scourge of addiction that has decimated too many people, their families, friends and communities. Opioids and COVID-19 must not be allowed to fester together, as one epidemic will surely add to the other. The cost of neglect is too great, for both virus and addiction. As a community, we have the opportunity to use our mobilized resources for both crises, for the betterment of all of us. One crisis must not allow us to lose sight of the other.

(Barry Schecter, LCSW-R,CASAC-G,MAC, and Thomas Nytch, DVM, write these letters in an effort to educate our readers about the nature of the medical and disease crises presently in our community. Barry is a Licensed Clinical Social Worker, also credentialed as a Certified Counselor for alcohol, substance abuse, and gambling. Thomas is a (retired) licensed clinical and regulatory veterinarian, with over 60 years of experience of using opioids in animals, both large and small, including original clinical research with Oxymorphone and Narcan.)