CUMBERLAND — It’s been a tough few months for everyone, but for folks whose personal situations were already fraught, the undue stress of COVID-19 has been especially unwelcome.
Though the country is slowly beginning to reopen, for many, the damage has already been done in terms of mental health. The Centers for Disease Control and Prevention identified people who have substance use disorder as among those who are more likely to be strongly affected by the stress of a major crisis like the ongoing pandemic. Those with other mental health conditions — that often exist in tandem with drug abuse — like anxiety, bipolar disorder and schizophrenia, are also at risk of having them exacerbated with isolation and the heightened potential for lapses in their treatment.
There are potential effects to one’s physical health, as well. In an April blog post, Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, wrote “the research community should be alert to the possibility that it (COVID-19) could hit some populations with substance use disorders (SUDs) particularly hard.”
“Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape,” Volkow wrote. Users of opioids and methamphetamine may also be vulnerable to the disease because of how their use affects respiratory and pulmonary health. Many people who struggle with addiction are also more likely to be homeless or incarcerated, further increasing their risk, she wrote.
Volkow identified another risk people with SUD may face in a separate April post: increased stigmatization.
“The stigmatization of people with substance use disorders may be even more problematic in the current COVID-19 crisis,” she wrote. “In addition to their greater risk through homelessness and drug use itself, the legitimate fear around contagion may mean that bystanders or even first responders will be reluctant to administer naloxone to people who have overdosed. And there is a danger that overtaxed hospitals will preferentially pass over those with obvious drug problems when making difficult decisions about where to direct lifesaving personnel and resources.”
On the subject of folks in recovery, NIDA suggests people currently in recovery may be “uniquely challenged by physical distancing measures.”
“Self-quarantine and other public health measures may disrupt access to medications and other support services,” according to information on their website. “For those in recovery from an SUD, social support is crucial since social isolation is a risk factor for relapse. Even though the physical distancing measures being implemented nationwide are important for reducing disease transmission, they may be especially difficult for people in recovery because they limit access to meetings of peer-support groups and other sources of social connection.”
‘Difficult for everybody’
Jade Kenney works at AHEC West as a community health worker through the Mountain Health Alliance program, focused primarily on recovery support services. In addition to her professional work, Kenney has lived experience: She has been clean from opioids for six years.
Kenney is also on the board at Fort Recovery, a club in downtown Cumberland for folks in recovery that provides a place for them to socialize with one another, free of the temptations presented by drugs or alcohol.
“It was really difficult for everybody when everything was shut down,” Kenney said, noting that the focused turned toward encouraging participants to reach out to one another regularly to maintain the sort of connection that’s vital for recovery. Unfortunately, she said, a lot of people have relapsed under the weight of the events of the last few months. Some of her clients, she said, cannot see her anymore as the terms of her grant deems her clients maintain sobriety. She hasn’t heard of any of her recovery network or clients dying from overdoses.
Of the 42 clients currently in her caseload, maybe 10 to 15 have relapsed, she said. Some folks had two years of sobriety, she said, “but self-isolation was just too much” and, when compounded with mental health problems, the stress became too much to bear.
One of her clients, Kenney said, reported to her that the sleeping medication he was given to deal with insomnia triggered cravings he hadn’t dealt with in awhile, to which he unfortunately gave in. The same man, she said, had told her he didn’t like the virtual meetings that became a substitute for their usual in-person ones.
In such a rural area, Kenney said, maintaining connection can already be difficult in the best of times for folks dealing with the one-two punch of poverty and substance addiction. Kenney said that AHEC’s Healing Allegany coalition, of which she is a member, recently applied for a grant that would allow them to pay for both phones and data for some of their clients who cannot afford it on their own, providing them with that crucial point of access. They’ve got the proposal in, but have not received word either way, she said. If received, 52 to 76 people could receive a phone.
AHEC will also soon start hosting a virtual recovery meeting, Kenney said, based on the SMART program, which she said is science-based rather than faith-based, as programs like Alcoholics Anonymous are. Kenney is a facilitator for the program, and said the training was “eye-opening,” and will present a good alternative for clients who struggle with their faith.
“It makes it hard to work through the steps when you can’t get to that point where you turn things over,” she said. “It’s about changing the way you think.”
‘It sticks to you’
Kenney’s teenage son is struggling with active addiction. During the quarantine period, she said, he’s “gotten himself into some trouble. … It’s been hard to keep him in the house. He doesn’t do well with isolation.”
Kenney said that because she and her son’s father — who died of a drug overdose when the boy was young — both were known around the community as addicts, a pall has unfairly been cast over her son. A life spent atoning for sins he did not commit from a young age took a toll on him, Kenney said.
“Parents wouldn’t allow their child to play with him because of who we were, which is really, really sad, because it leads to where we are now,” Kenney said. He lived with his grandmother for a time, and attended a private school, but the “feeling of rejection” was in him from the time he was 5 years old, “and set him up for failure.”
That kind of stigma, Kenney said, is something that stays with a person for a long time, unjust though it may be. It drove her to leave the East Coast entirely when she got sober in 2014, she said, and that kind of separation likely contributed to the success she’s experienced with her own recovery.
Accordingly, Kenney said she has considered leaving the area with him in favor of somewhere with access to more of the sort of resources that could help him in his own journey.
“It sticks to you. It’s taken me years to change who people see me as,” Kenney said. “I think it’ll probably be difficult for him to make something of himself or change the views of others.”
During the last few months, she said, he’s been arrested four times, the most recent of which was just two nights before Kenney’s phone interview with the Times-News for this story. He’d been staying home since then, she said, and was hopeful he’d continue to do so.
She shared a story of a recent incident where a resident posted a video of Kenney’s son breaking into their car while under the influence. They have since worked out a deal amongst themselves, she said.
It was “very detrimental to his reputation,” Kenney said, and although it’s since been deleted, the video was shared fairly widely before that.
“The damage that video did made things so much worse for him,” she said. “She put a really nice post out saying she didn’t want to make his life harder than it’s already been. … It’s difficult. I’ve got a lot of respect for her, but damn, that’s hurtful.”
‘Upset the karma’
Her brother is in from Boston, she said, visiting while he is new in his own sobriety from alcohol. Kenney said she was hopeful that the combination of his recent trouble and seeing his uncle turn a corner live in real time would be a good influence on her son.
“My son takes what I say with a grain of salt, so to speak, but hearing it come from my brother, I think, is changing his perspective,” Kenney said. “It’s not my mom saying ‘Don’t do this,’ now he’s got his uncle saying ‘Look, now you’ve upset the karma. … You’ve got to change your path.’”
She also knows the decision to change his ways is not one she can make for her son. Coming down hard has not worked, Kenney said, so she chooses to let her son know instead he is loved and supported while at the same time not “bailing him out” and “making him face those consequences.”
For her clients, she said, the mental toll of isolation has “absolutely” driven relapse. Referring to the same man she mentioned earlier, Kenney said he shared that he knew he was making inappropriate decisions that ultimately “pushed him even closer to relapse,” like starting a relationship with someone relatively new in her own sobriety. That led them both to relapsing, Kenney said, and she has sought treatment while he has renewed his focus on maintaining his own sobriety.
Fort Recovery has since reopened, with measures that incorporate social distancing in mind, she said. Tables have been removed, and chairs have been placed six feet apart. Members won’t have access to communal coffee and other items previously shared for the time being, and they are disinfecting before and after each meeting, not passing anything around.
“Our biggest fear is that someone new will show up with maybe the desire to get sober or new to recovery and will not be permitted to come in,” she wrote in a follow-up email to the Times-News. “We are offering any overflow to connect to our WiFi and listen to the meeting in our parking lot or sit in the back at the picnic table. And I would hope that a seasoned member might go outside to allow the newcomer to come inside if that should happen.”
They’ve seen fewer people come back since reopening than she expected; Kenney speculated during the phone interview that people may be apprehensive to leave their homes at all after having been kept in for so long. Still, she said, they’re taking precautions “to keep everybody as safe as possible.”
Board members who are educated in public health, she said, are saying it’s too soon to open at 50% capacity and accordingly urge strict measures to prevent spreading illness. Other members, she said, are anxious to reopen at full capacity and are vocal about wanting to do so.
Kenney said she does fear that there will be a second wave of spikes in the rate of disease driven by businesses being permitted to reopen too soon. Should there be a second wave of closures spurred by another spike in the rate of the disease, Kenney said that there is, at least, more of a blueprint for how to proceed this time.
“I think it could go both ways,” she said of how one may feel on a personal level. Some might feel better equipped, while others might feel the sort of futility that leads them to relapse.
“It’s like ‘Well, the world is ending, I might as well go get high,’” Kenney said. “Especially when we have no idea what’s going to happen.”
‘In the trenches’
Stephanie Hutter-Thomas works as a community educator through the University of Maryland Extension’s Rural Opioid Technical Assistance grant. She works covering Western Maryland, and also works closely with a counterpart on the Eastern Shore.
ROTA, she said, is funded through SAMHSA and aims to improve mental health literacy through a variety of evidence-based programs. They also operate a website that contains a comprehensive list of available resources locally, for community members and health care professionals alike, and Hutter-Thomas said they’re also focused on building local coalitions to that end to address the opioid crisis locally.
She has “been on the educational end of things, but also been in the trenches with those individuals” struggling with their drug use, Hutter-Thomas said.
“I’ve been impacted by it in my own family a great deal,” Hutter-Thomas said. “My husband is in recovery, and he’s been doing great for years, but those were some of the hardest years for us as a family.”
For families in that position, Hutter-Thomas said, the individual’s drug use has effects on them all, ranging from financial strife to interpersonal problems. Her academic work specialized in psychology, but not specifically addiction, she said. She came to that as a field of work through her own lived experience.
Her current role with the ROTA program has so far gone differently than she expected.
“We had a big charge ahead of us of collecting this data … and because COVID moved us to a virtual environment, we could reach larger groups of people in a shorter amount of time,” Hutter-Thomas said. “I would have to be running all over Western Maryland every day, teaching 20 people one place one day and 25 in another the next. Now we have webinars where we draw anywhere from 50-150 people.”
Their first webinar, she said, had 160 registrants and 101 ultimately participated, which “floored” her.
“We’re going to reach the people we set out to reach in spite of this happening,” Hutter-Thomas said. They have been virtually collaborating with others across the state for virtual webinars, she said, that have so far fared very well. The trainings are attended by “everyone under the sun you can think of,” Hutter-Thomas said, from folks who are in recovery and working for a peer support certification and their families to those who work with addicts professionally.
“We’re able to reach a larger classroom,” she said. “That first webinar … in person, I’d have maybe had 30 people in one location, and then I’d have to travel somewhere else the next day for another 30 people. … But because we can do this online, we can knock out training for 100 participants in a two-hour session. We can deliver to a much larger audience at any given time.”
In general, she said, the pandemic fuels many of the root causes of substance use, like mental health problems and poverty, along with “general hopelessness and despair.” Forcing isolation on top of gloom-and-doom in daily life “fuels a sense of hopelessness.”
There is no conclusive data yet, Hutter-Thomas said, as the situation is still so new. But in one recent meeting, she recalled hearing a DEA statistic that stated overdoses are suspected to have risen by as much as 20% compared to the same time last year.
“They don’t have hard data yet, so all they’re looking at is the number of overdoses reported last year versus what they’ve seen in the last few months, and then compared the two,” Hutter-Thomas noted. “But it stands to reason the COVID situation, mixed with all the things that came with … seems to have contributed.”
Someone she had grown to know through her own work with recovery and drug use in the region was one such casualty, Hutter-Thomas said she recently learned. She called his loss tragic, and said that in life, the man had been someone devoted to helping others in their own journey with sobriety.
“The COVID situation just became too much for him,” she said. “He had a slip, he used and it killed him. It’s just the saddest thing. That’s just one story of many, too.”
Many people in recovery who work in peer support come to view it as an essential part of their identity, Hutter-Thomas said. It’s “part of their own personal checks and balances, how they keep themselves on the straight and narrow,” she said.
Oftentimes, they redirect their energy toward helping others as a means of helping themselves, and when they are deprived of that outlet, they suddenly feel “very helpless … and I think for many, that helped lead to a feeling of isolation and a lack of purpose.”
Her husband, Hutter-Thomas noted, “has done fantastic” with everything, and is close to six years clean. Having his family close by was helpful, she said, as they focused on artistic projects around their Cumberland home.
“It also helps that … we weren’t experiencing the financial devastation a lot of people were,” Hutter-Thomas noted. Her husband, who is a tattoo artist, was out of work when everything was shut down, she said, but she and their daughter both remained employed, so their income wasn’t as disrupted as it was for other families.
“There isn’t a day that’s gone by where I haven’t been reminded how fortunate we were that our experience during COVID was generally a very positive one,” Hutter-Thomas said. “In fact we were like, ‘I don’t want to go back out into the real world. I like this.’”
It could happen again
Another wave of infections, she speculated, could potentially trigger a rise in overdoses similar to or larger than the one suspected to have taken place over the last few months. The quickness with which many organizations adapted their operations to suit their new guidelines for operation was “pretty impressive,” Hutter-Thomas said, and a hopeful sign should a second wave come to pass.
“That was the big scary thing … and they adapted pretty quickly,” Hutter-Thomas said. She expressed some trepidation about the relaxed guidelines for telemedicine that were implemented at the height of the pandemic, specifically about what it could mean for monitoring the prescription of opioids.
“Now all of a sudden, if you’re crossing state lines with telemedicine, that takes away some of the effectiveness of these monitoring programs,” she said, noting that she is not an expert in how those programs are administered. “I don’t know what that’s going to look like. … If we continue to use telemedicine for a lot of this stuff, we may have to look at adjustments for monitoring programs and how those work.”
More preparation and community education could make the difference if there is a next time, she said.
“I really think everybody did the best they could in the scenario,” Hutter-Thomas said. “… I think what it really comes down to now is many programs now will acknowledge that if this happened once, it could happen again, and they’ll develop their own emergency response plans.”
Follow staff writer Lindsay Renner-Wood on Twitter @LindsayRenWood.