Guest columnist Livia Cox: An epidemic within a pandemic: Opioids and COVID-19 

  • Livia Cox, a 2018 graduate of Amherst Regional High School and a rising junior at Wesleyan University, is an emergency medical technician and co-founder of a nonprofit, the Middletown Harm Reduction Initiative. SUBMITTED PHOTO

  • Livia Cox, a 2018 graduate of Amherst Regional High School and a rising junior at Wesleyan University, is an emergency medical technician and co-founder of a nonprofit, the Middletown Harm Reduction Initiative. SUBMITTED PHOTO

Published: 7/12/2020 1:00:12 PM

As I pry open the eyes of a limp woman, one gloved hand on her face, the other reaching around for my stethoscope, flashlight gripped between my teeth, I notice her pinpoint pupils.

Her fingers are blue, her breaths shallow at best. She moans slightly when the cuff around her arm tightens. She’s showing clear signs of overdose, likely opioids. From her bruised and dotted arms, I’m guessing heroin. Per protocol, I administer naloxone, an antagonist to the opioids. Two minutes later, as if startled awake by a nightmare, she stares me in the eye. The naloxone is working.

She tells me she’s fine, that I’m overreacting, and tries to disentangle herself from the myriad of cords that hold her hostage to the stretcher. With every joule of effort she exerts, she fights a losing battle, slowly slipping back into slumber. More naloxone. It works again, for now at least. We’re getting closer to the hospital, and I need her to hang in there until someone with expertise beyond my new EMT license can take over.

We’re both 20 years old.

I’m thinking about her a lot today, because, along with the other 10.3 million people who struggle with opioid addiction in the U.S., right now she’s a part of an epidemic within a pandemic. I wonder if, wherever she is, she has access to naloxone should she overdose again. I wonder if she can get clean needles; it’s hard enough when the world’s doors are open. I wonder, as the number of hospitalized people with COVID-19 continue to surge, if she’ll be able to access the care she’s entitled to, as the virus continues to infiltrate and disrupt daily life.

On a good day in a U.S. hospital emergency department, the average wait time for an urgent case is 30 minutes, according to the Centers for Disease Control and Prevention (CDC). That’s also how long it can take for naloxone to wear off. On a less than good day, well, we’re looking at a potential death by overdose before even making it through the gates of triage.

I’ve spent more time in ERs than the average healthy 20-year-old. I’ve seen firsthand the treatment that patients who struggle with addiction face in the emergency room setting. Often deemed nonurgent the minute they’re stable (despite naloxone’s waning effectiveness after 30 minutes), these “frequent flyers,” are relegated to the sides of the ER floor and assigned a technician to babysit them until they’re deemed dischargeable.

While in truth there is not a lot that an ER can do to “cure” an addict, it’s no wonder that 52% of overdose deaths occur within three months of an emergency room visit, according to National Institute of Drug Abuse. I fear that this will only worsen in the coming weeks.

COVID-19 cases are filling emergency departments to the brim, and hospitals with poor infrastructure and funding, such as New York City’s Elmhurst Hospital — operating far beyond capacity — bear the brunt of the burden. Concurrently, overdose deaths are spiking nationwide, with Pennsylvania, New York and North Carolina reporting a staggering number of opioid deaths just last week.

A visit to an emergency room may not cure an addiction, but it gives patients a second, or third, or 10th chance at life, a chance to get connected with a harm reduction coalition or rehabilitation facility that can provide the support that an ER visit lacks. The acute treatment that ERs provide in an overdose crisis saves lives. Patients with an opioid dependence rely on them.

Nondiscriminatory disease

Opioid addiction is often described as a nondiscriminatory disease that can equally affect and claim the lives of all demographics irrespective of socioeconomic status, race, or medical history. That’s not true.

Although addiction has an undeniable neurogenetic basis, people in economically disadvantaged regions are more likely to use and abuse opioids. According to the U.S. Department of Health and Human Services, those on Medicaid are significantly more likely to be prescribed opioids — and at higher doses and longer durations — increasing their risk of developing an addiction to opioids and subsequent opioid use addiction. The disparate impact of COVID-19 on Black Americans, who are more likely to experience hospitalizations and death due to the virus, exacerbates the current challenges for families and individuals struggling with opioid addiction.

For some, the temporary closing of libraries due to COVID-19 impedes their ability to use this time to catch up on new reads. For others, library closures have a far graver impact. Libraries have long served as day shelters for the homeless and destitute.

As the opioid epidemic continues to storm the nation, with the homeless nine times more likely to die of an overdose than the housed, libraries have also become a common site for opioid use and overdose, which is why it’s not uncommon for librarians to carry naloxone on their person.

Addiction doesn’t vanish amid pandemic times; those with opioid addictions will continue to use. For the homeless who use opioids, closed libraries don’t mean subsiding addiction. They mean using, and overdosing, alone. They mean overdosing in the cold. They mean overdosing with a lower chance of revival.

The acceleration of climate change will likely spur several new waves of pandemics. As temperatures rise, pathogens thrive. Bats and other vectors can easily modify their body temperatures to adjust to environmental changes brought on by climate change.

They can host pathogens without falling ill. But we humans aren’t as lucky; a body temperature change of even two degrees can bring on the chills and aches. We’ll fall ill from the pathogens that our fellow earthmates will host but remain impervious to.

I was 3 years old during the SARS outbreak. This is the first pandemic I’ll be able to remember. It probably isn’t the last. We need to prepare for the wave of pandemics we’ve brought upon ourselves; and that means looking out for vulnerable populations, whose chronic and life-threatening circumstances mean they are disproportionately affected.

Livia Cox is a 2018 graduate of Amherst Regional High School and a rising junior at Wesleyan University. She’s also an EMT and the co-founder of a nonprofit, the Middletown Harm Reduction Initiative..
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