Stigma is a mark of shame or disgrace, and people who struggle with addiction are already very familiar with this. It can perpetuate an endless cycle, where the drug user takes more drugs to cope with these feelings, thus furthering their addiction and inevitable stigma. Many social factors influence stigma, but something we haven’t examined before is how a pandemic, such as COVID-19, can affect this vicious phenomenon. People who are in a panicked state can either exhibit their best or worst qualities, and these can be seen especially when dealing with their fellow humankind who are struggling.
One concern with COVID-19 is that those who were getting close to entering treatment may find themselves derailed and wondering if it’s even safe anymore. Coincidentally, stigma also works to keep people from coming forward and asking for help due to fear of ridicule or belittlement. With these two factors working in tandem, people with addiction issues may find this to be an exceptionally challenging time. Getting past the stigma is step one, but then what about the virus? Treatment centers are often comprised of many individuals from different areas sharing close quarters or living in a communal-like setting. This doesn’t mean treatment settings are dangerous necessarily, but in order to remain safe they should be staffed with adequate medical personnel and new clients should undergo a screening and segregation period. Smaller treatment centers, or those which are more remote, and patients stay longer, would theoretically be the least dangerous due to the lower rate of patient exchange between admission and discharge.
For those who don’t seek to enter treatment during this time period, the risk is even higher. As we’ve seen in China and Italy, once an area is hit hard with COVID-19 the medical systems become completely overwhelmed. Proactive measures are difficult since the main lifesaving treatment consists of ventilators or ECMO (extra-corporeal oxygenation). There are only a limited number of these machines in existence in the United States, so the availability is well below what will be needed if the virus does take it’s expected course. With hospitals potentially overflowing it means that people who aren’t ill with COVID-19 but still need emergency medical treatment may not be able to get it. Going to hospitals also means a greatly increased risk of being exposed to the virus. Since overdose deaths share a commonality with the virus of respiratory distress, people with substance use disorder are even more at risk. Some hospitals have already had to choose which patient gets the last available ventilator and given the stigma towards those with addiction, this could become a frightening dilemma.
Another factor, which has already begun to occur, is the diverting of funds away from the fight against the drug epidemic and towards the fight against COVID-19. Recently, the Trump administration decided to transfer $4.9 million from substance abuse and mental health programs to fund its coronavirus response. While this may seem warranted given the nature of this pandemic, the National Council for Behavioral Health’s president was quick to dispel that idea by pointing out that this action is the quickest way to interrupt the progress made in the fight against the opioid epidemic. He also pointed out that the decision is ironic, given that both issues have separately been declared public health emergencies. Things like this do make one wonder what other areas were overlooked as potential alternative funding sources, and how the nation will benefit from robbing Peter to pay Paul. Again, this may be yet another situation where stigma negatively impacts people who are struggling with substance abuse, as it may by easier to justify such a decision when considering COVID-19 victims as “innocent” by comparison.
Regardless of political decisions, one thing is clear. Both substance abuse and COVID-19 are major public health problems, and both can heighten people’s sense of stigma. This can play out in negative ways that cause people to be treated unfairly, or act differently out of fear. It’s only a matter of time before we realize the full impact of this virus, and its effects on those with substance use disorder. However, it’s safe to assume that when they say mortality rates are higher for those with underlying health conditions, substance abuse should be considered such. And anyone considering delaying their efforts to get help for any reason should keep in mind that with two major epidemics like these, anything that can be done to improve one’s health and wellbeing will only increase their chances of survival. It’s better to act now than to wait until there are no options left.