The Light at the End of the Tunnel

When the coronavirus pandemic swept across the U.S. early last year and was recognized by the Centers for Disease Control (CDC) as a public health emergency that demanded an immediate response from all our citizens, most of us responded as our public health officials asked. We hunkered down and sheltered in place. We limited our trips outside the home to what was essential. We shopped for food, went to the doctor, helped our relatives, and in the case of front-line, essential workers, we went to work every day. We learned to wear masks, keep social distance, and wash our hands more than we ever had before.

Now, a full year later, the vaccines have arrived. As vaccination rates increase and new cases decline, we can see the light at the end of the tunnel. Realistically, it looks like we’ll arrive at our new normal sometime around the beginning of the next school year — maybe mid-August. Optimistically, it’s not unreasonable to think we may arrive at our new normal a little earlier. We could get there by summer — maybe mid-June.

Either way — and barring unforeseen events — most of us can agree that the end of the pandemic is in sight. If we work together, it’s within our reach. We’ve shown ourselves that, when we work past our differences of opinion and disagreements about our approach, we can come together and do what’s best for the general health and welfare of all our citizens.

I’m not sugarcoating all this, either. Everyone knows the road was neither smooth nor direct because everyone watched our progress play out in the news every day. But we have a clear, discrete, physical manifestation of the kind of cooperation I’m talking about: the vaccines.

We Can and Will Prevail (Over the Forgotten Epidemic)

There’s a set of facts we can lean on when we address the other health crisis our country faces. The one many have almost forgotten: the opioid crisis. When the coronavirus pandemic arrived, we were making progress on opioids. Things weren’t perfect, but the situation we were in is analogous to the one we’re in today: getting better. Opioid overdose rates were decreasing. Public and private partnerships were beginning to impact prescribing practices. Government agencies had adjusted specific policies and procedures at the request of the medical community in order to remove barriers to treatment and improve access to the life-saving support and care that so many people needed.

We could see the light at the end of the tunnel.

Then, COVID-19.

A full year of all-hands-on-deck later, and we see the light at the end of that tunnel.

How did we do it?

The same way we’ll beat the opioid crisis.

Here’s the set of facts we can lean on when there’s a refocus on opioids. In less than a year, we did the following:

1. Engineered and completed clinical trials for a vaccine for a novel virus, a process that typically takes 4–5 years, minimum, and sometimes twice as long.

2. Manufactured hundreds of millions of doses of the new vaccine.

3. Purchased enough doses to vaccinate the entire population of the U.S.

4. As of March 23rd, administered roughly 83 million doses, with close to half of people over 65 vaccinated.

5. Made real progress on therapeutics that can significantly decrease COVID-19 hospitalizations and deaths.

Seen as a whole, what we’ve done is an amazing accomplishment achieved under serious time constraints and a host of adverse circumstances.

I’m saying all this because we need a pep talk to get us ready for what’s next. I’m pointing out our ability to move mountains for a reason. When we decide failure is not an option, what happens is that we meet challenges and overcome obstacles. We should not forget that in the midst of all the turmoil of 2020, we met and overcame one of the biggest public health challenges in our history.

We need to remember that because we have another serious challenge ahead.

Overdose Deaths Increased in 2020

That’s the reality before us. While most eyes were on the coronavirus pandemic, more people died of drug overdose than in any 12-month period on record.

That’s a hard fact for me to accept, but it’s real, and I have to. It’s hard because we worked tirelessly to change the facts on the ground and rewrite the narrative on addiction and opioids in our country — and as I mention above, we were making progress. Drug overdose deaths rose steadily from 1999 to 2017, with accelerated increase between 2014 and 2017. In 2017, National Institute on Drug Abuse (NIDA) reported more than 70,237 deaths by drug overdose — the largest total we’d recorded at that point.

Then the numbers started to turn around.

In 2018, the CDC reported 67,367 deaths by drug overdose. My colleagues and I who work in addiction treatment believed our collective efforts were beginning to pay off. When the numbers rose again in 2019, we understood exactly why. An influx of the powerful synthetic opioid fentanyl and carfentanil, produced illicitly and sold on the black market, made anyone who used street heroin or purchased prescription opioids for non-prescription purposes even more vulnerable to overdose and death than before.

But because we understood exactly why — the fentanyl and carfentanil — we knew exactly what to do to bring the numbers back under control. We increased access to the lifesaving drug naloxone and reduced barriers to treatment by reassessing rules around medication-assisted treatment (MAT). We redoubled our awareness and education efforts, focusing specifically on the dangers of illicit opioids like fentanyl and carfentanil that threatened to derail our progress.

Then COVID happened.

And our progress on addiction and opioids virtually evaporated. It was eclipsed by a harsh ancillary effect of the pandemic: the cumulative stress of COVID-19, which led to a dramatic increase in mental health and substance use problems for almost all demographic groups in the U.S.

The New Challenges

Earlier, I gave you a list of five things we accomplished over the past year vis a vis COVID-19. I offered them as a pep talk. Now I’m going to give you the five reasons we needed that pep talk. Fair warning: this is not a feel-good list. This is a realistic assessment of where we are and the work before us.

Five Hard Facts About COVID, Mental Health, and Addiction

1. In December 2020, the CDC reported an unprecedented 81,000 drug overdose deaths — a record for any 12-month period in our history.

2. In June 2020, the CDC reported that 40% of adults in the US said they struggled with mental health or substance abuse issues.

3. The same CDC report indicated that 26% of adults in the U.S. said they experienced trauma and/or stress related symptoms during the pandemic.

4. Rates of depression among adults in the U.S. during the pandemic, increasing from a prevalence rate of 8.5% before the pandemic to a rate of 27.8% during the pandemic.

5. A large-scale study conducted by the New York University School of Public Health showed that close to 30% of adults in the U.S. said their alcohol use increased during the pandemic, with the largest increases observed in people with preexisting mental health disorders such as depression and/or anxiety.

To connect the dots, it’s accepted fact that an increase in stress can lead to an increase in the frequency and severity of the symptoms of mental health disorders. An increase in stress can also exacerbate the symptoms of an alcohol or substance use disorder (AUD/SUD) — meaning increased stress can lead to more drinking and drug use. It’s also accepted fact that an increase in the frequency and severity of mental health symptoms can lead to an increase in the symptoms of AUD/SUD — meaning increased mental health symptoms can lead to more drinking and drug use.

Therefore — connecting almost all the dots — what we have brewing, or rather, what we have waiting for us, or rather, what we really have right now happening under the surface is a mental health and addiction crisis. The crisis that already existed — the opioid crisis — did not disappear during the pandemic. According to the data, it got worse. It got worse because of the pandemic, and while we’re in this unusual in-between time — we have vaccines but do not yet have the optimal percentage of our population vaccinated — it will get worse if we don’t recognize what’s going on and prepare to meet it head on, as soon as possible.

The dot that I didn’t include is the reason I can end this article on a hopeful note. I’m tempted to say it’s five dots rolled into one: it’s the five points I listed in the first part of this article.

But it’s not really those, at all.

That dot — and our reason for hope — is the fact that we met the greatest public health crisis in a hundred years and it looks like we’re finally winning.

It’s the amazing effort made manifest in the coronavirus vaccines we’re now hard at work distributing.

It looks like we’re finally winning.

I’m being cautious with my language because I don’t want to get out ahead of my skis — but we are on the way to full vaccination, herd immunity, and the end of the coronavirus pandemic. This makes me believe that when we apply the same force of will, determination, and collective effort to the looming mental health and addiction crisis, we can meet it and defeat it.

I’m cautious, I’m an optimist, and I also put my faith in facts. That’s why I know we can handle what’s coming next.

The fact of the vaccines makes me a believer: it looks like we can finally defeat the opioid crisis.