COVID-19 and Substance Use Disorders

With unprecedented times comes unprecedented challenges, and the COVID-19 crisis has proven that to true, especially regarding drug-related overdoses. Recent studies indicate that substance-related overdoses and deaths are on the rise, with more than 35 states reporting increased mortality as a result of opioid use.

This rise is attributed to numerous factors, and the Director of the National Institute on Drug Abuse (NIDA), Dr. Nora Volkow, discussed these contributors in a conversation published on the NIH’s Director’s Blog.

Dr. Volkow explained that many services that were previously available to individuals and families affected by substance use disorders are no longer accessible. Programs such as syringe exchanges, Narcotics Anonymous meetings, and hospital emergency departments are either shut down or operating with restricted hours and access. The added stress of not being able to access these programs compounds with the current strain of the pandemic. This could result in dire consequences as an increase in stress could lead to relapse and drug use.

Virtual visits and meetings with doctors, counselors, peers, family, or other support systems can be a lifesaver during this time of isolation. Decreased face-to-face interactions take an emotional toll on everyone, especially those at higher risk, so these virtual interactions are crucial.

Individuals with substance use disorders may be more vulnerable to COVID-19 because of the effects of drugs on the body, especially the pulmonary system. With pulmonary function being the primary target of COVID-19, individuals consuming drugs are at greater risk for experiencing heightened effects if the virus is contracted. Another risk is that individuals with substance use disorder are significantly less likely to have medical insurance than the rest of the population.

The NIDA website and Substance Abuse and Mental Health Services Administration (SAMHSA) are resources that provide evidence-based information and treatment program information for people with substance use disorders. If you have a family member or friend who is struggling, these resources could be a lifesaver.

Rights and Responsibilities of Kinship Caregivers

Kinship Caregivers are family and friends who step up and become responsible for raising a child when their parents cannot care for them. The child may live with kinship caregivers for a number of reasons. There are two types of kinship care, informal care is a private arrangement between the parents and caregiver, while formal care occurs when a child is in the custody of a public child welfare agency. The rights and responsibilities of caregivers vary based on these arrangements, so it is imperative the adults in these roles understand their responsibilities. 

Custodial agreements range from informal custody to kinship guardian, with legal custody and direct custody in between. The primary difference between non-custody and custody arrangements is the responsibility to make major life decisions regarding the child’s upbringing, education and medical needs. A caregiver can attain legal custody through a custody order by a judge, legal guardianship, which is generally granted in a probate court, or adoption, which gives complete legal guardianship over a child.

In both arrangements, the caregiver is responsible for providing a safe environment that meets the child’s basic needs for food, clothing, and shelter. The caregiver must provide the child with transportation to any required appointments and encourage social and recreational activities which are fundamental to a child’s growth and success. The caregiver should monitor the progress of the child’s social, academic and personal growth, and work with professionals as well as the child’s birth family to ensure positive development.

The children in kinship care often struggle to cope with complex feelings as a result of challenging family dynamics. Caregivers can provide emotional support by ensuring the child feels included and an equal member of the family.

Both the child and caregiver need a supportive, comfortable, and secure environment. Child welfare professionals should provide the caregivers with training and a support system to ensure a successful homelife for everyone involved. There should also be consistent communication to discuss and address challenges that may come with bringing a child into a new home. Caseworkers can provide support through offering therapy and support groups for families and children.

Source:

https://fosterandadopt.jfs.ohio.gov/wps/portal/gov/ofc/kinship-care/resources-for-kinship-caregivers/rights-and-responsibilities-kinship

Outdoor Activity Balances Leniency and Neglect

Outdoor activity is essential to the mental and physical development of children, but children may not get enough outdoor playtime if parents fear their decision to let their children play outside alone will be reported as neglect. Unfortunately, due to a lack of resources, some parents must choose between letting their children play outside alone or not at all. 

Child Protective Services cannot always distinguish between neglect and more lenient  parenting practices. The systems in place to protect children from neglect can sometimes have adverse effects, especially in vulnerable communities that are more strictly monitored by authorities.

False reports of neglect are harmful to the accused families and distract from actual cases of child maltreatment. A report called Rethinking the Parenting Paradigm includes a health assessment of child protection policies in Montgomery County, Maryland from 2015. The results showed that:

  • Fear of being reported to child protective services is one reason why parents limit outdoor freedom. 
  • There is a higher risk of being reported for neglect than of actually being found neglectful. 
  • Certain vulnerable populations are at higher risk of being reported and investigated, while not necessarily having a higher likelihood of neglecting their children or of leaving them unsupervised. 

The amount of time that children spend playing outdoors has significantly decreased over the years, and that time has a direct impact on long-term health. The average American child spends as little as 30 minutes of unstructured outdoor play a day and spending half as much time outdoors as they did 20 years ago. The lack of outdoor play is connected to long-term health issues such as obesity, anxiety, depression, and other developmental concerns.

Public debate on acceptable styles of parenting is polarized, and spans between two extreme styles of parenting: “helicopter” and “free range.” While responsible parenting allows for a wide range of behaviors, parents that exercise “free range” are more at risk of getting involved in child welfare systems.

The Ohio Children’s Trust Fund defines neglect in broad terms: not providing a child with food, shelter, medical care, education, supervision or clothes. But without laws that distinguish between neglect and “free range parenting”, child protective services may unintentionally harm the children it seeks to protect.

This is an area that CPS should continue to refine to provide the most valuable care to those who need it most.

Purdue Pharma Offers Reparations for Individuals Affected by Opioid Crisis

The aggressive marketing and pharmaceutical sales of opioids in the past decade have left a devastating wake of addiction and death in the United States. Now, individuals who have been harmed by prescription opioids have the chance to file claims against Purdue Pharma, the maker of the painkiller OxyContin. Until July 30 of this year, people who have suffered from the effects of prescription opioid use will have the opportunity to seek compensation.

As of June 11, 2020, about 17,800 personal-injury claims have been filed by people who believe they or their loved ones were harmed by these prescription opioids.

Purdue Pharma is widely believed to be the instigator of the opioid epidemic. In 2019, the company declared bankruptcy which brought the more than 2,000 lawsuits against the company to a halt. “Purdue Pharma and its owner, the Sackler family, reportedly set aside $10 billion or more and put the company into a public trust to pay individual victims’ claims,” according to Newsomelaw.com. The company launched a $23.8 million advertising campaign to announce its opportunity for individuals to file claims.

This bankruptcy is unusual in that the implications of this company’s actions have spurred a national health crisis that has taken hundreds of thousands of lives and created a case for reparations beyond what can be quantified. It cemented a systemic crisis that will take years to undo.

It was also complicated by the sordid actions of the Sackler family, Purdue Pharma’s owners, who had transferred about $1 billion to foreign locations prior to filing bankruptcy. The case which involves Purdue Pharma filing for bankruptcy, also proposes a settlement worth more than $10 billion over time, plus $3 billion from the Sackler family over the next seven years, and an additional $1.5 billion from the sale of the family’s global pharmaceutical business, Mundipharma. It would also require that the family give up ownership of Purdue Pharma.

If you or a loved one has been harmed by the effects of opioids sold by Purdue Pharma, you can access a list of instructions on how to file a claim here.

West Virginia Families Step Up to Foster

In West Virginia, the growing opioid crisis demands more foster parents than ever before. Responsible adults are needed to raise children who have been affected and are no longer able to live safely in their homes.

According to an article by NBC News, the foster care system contains more than 7,000 children in West Virginia alone, and more than 83% open child abuse and neglect cases in West Virginia involve drugs.The number of children far outweighs the 4,000 licensed foster homes in the state. Foster parents are the heroes of the opioid crisis. They are providing children with safe home environments, and breaking the cycle of abuse that is embedded in families struggling with opioids.

Louisa and Nikki Snuffer are among those heroes. They are the parents of eight children from the West Virginia foster system who devote their lives to being full-time caregivers for these children, many of whom were born with physical and mental disabilities.

“It didn’t take long for Louisa and Nikki to realize that the trauma the children had been through would take years to process and heal,” Hannah Rappleye and Brenda Breslauer wrote, in the article ‘Love, over everything’: As West Virginia struggles with foster care crisis, families step up.

 

Nikki Snuffer, 35, hugs her daughter Harlow, 6 in Charleston. Snuffer and her wife Louisa adopted Harlow and seven other children impacted by the opioid epidemic. With slightly less than 4,000 licensed foster families, state officials are desperate to recruit families like the Snuffers. Hannah Rappleye / NBC News

 

When mothers use opioids throughout pregnancy, children are born with an inherent dependency on the drug. Without a healthy opportunity to live a clean life or the positive influences to abstain from drug use, the cycle repeats itself.

“The crisis has strained the system significantly,” Rachel Kinder, a program director at a foster and adoptive families nonprofit center, said. “Five years ago, my agency was happy to talk to 400 families who were considering being foster parents. Now, we talk to about 2,000 a year, and it’s never enough.”

Kelly May is a permanency facilitator at the Children’s Home Society, who works to place children in safe homes. Her job allows her to give back to children who have struggled in ways that she herself endured, as she entered the foster care system at 15 years old.

“We really need people who are committed” to becoming foster or adoptive parents, May said. “We are raising the next generation.”

Harm Reduction Ohio partnership

The ECI program is excited to announce its partnership with Harm Reduction Ohio, a non-profit organization that supports drug policies based on science, health, compassion and human rights. HRO is the only layperson organization that is legally authorized to distribute naloxone in Ohio. For the duration of COVID-19 shutdowns, HRO is providing free naloxone across the state. The program will return to its normal distribution, aimed at people who use drugs and those directly in contact with them, once coronavirus restrictions are lifted.

HRO’s efforts are focused on mitigating negative impacts on people who are drug users. Some of their main objectives include reducing harm associated with drug use and policy, empowering people who use drugs to care for themselves and others, promoting health equity, educating about treating drug users without stigma, and ending criminalization of people who use drugs. The attached table and map includes information on Syringe Exchange Programs throughout Ohio, which overlap with some of the counties involved with ECI.

Visit the Harm Reduction Ohio website and click on the “Get Naloxone” page to order free naloxone.

Stress and Isolation Can Impact Substance Use

People who have a history or are currently dealing with addiction are especially vulnerable to relapse when faced with isolation, and this is especially worrisome given the intensity and duration of isolation associated with the COVID-19 crisis. With restrictions on travel and unusually stressful economic and social changes, people across the world are forced to find ways to pass time and to cope with stress. Substance use can be a maladaptive coping strategy that many people may fall back on during these difficult times.

A Forbes article noted that the sales of spirits spiked about 50% the week of March 21, a week when the onset of the pandemic began to overwhelm the United States.

“Nationally, tequila saw the biggest spike, up more than 75%, underscoring its status as the fastest growing spirits segment in the U.S,” said Forbes contributor, Joseph V Micallef. “It was followed closely by gin. Wine sales were up 66% and beer sales, in a reversal of the usual recession consumption pattern, lagged even though they still rose 42%.”

A study was conducted by the Pacific Neuroscience Institute (PNI) on the effects of stress and isolation on relapse. The results indicated that the effects of people who struggle with drug or alcohol use are at increased risk of relapse in isolation. “Preclinical studies show that animals kept in isolation are more likely to press a lever to receive a dose of drug or alcohol than animals able to interaction with other animals.”

The connection between isolation and an increased need for stress-relieving rewards is proven to be a chemical reaction. The PNI recommends that those who are struggling seek out regular social interactions with sober family members, friends or other people who can offer support. There are online platforms set-up to support individuals who are struggling and cannot receive in-person help during the pandemic.

AA and SMART Recovery are two recovery platforms that have online services including specialized group forums, peer support groups, meetings, and other events designed to create remote support systems for individuals in need.

Doctors and mental health specialists are also accessible throughout this time and available to ensure that everyone has the resources they need during this global health crisis. Personal health is of the utmost priority during this time and is something we could all focus more time on.

Reach out to any people or organizations who can help you get through this difficult time, and don’t forget to make your support available to others as well. We’ll all get through this together.

Grandparent Kinship Caregivers: Parenting Stress

To understand the opioid epidemic in America, it is crucial to understand the structures of families who are affected, and how they must adapt to non-traditional family dynamics as a result of addiction. Research and interventions often focus on the individual living with addiction or a substance use concern as a means to provide treatment services. Growing research and the attention of child welfare agencies, mental health providers, and state and local officials are shedding light on the complexity of addiction as it relates to family units. The lives of individuals who are addicted, their children, and other relatives are often uprooted and refocused around the opioid addiction and the repercussions of that disease.

As the number of individuals affected by opioids increases, so does the number of children affected. These effects can be a result of physical abuse, ignoring children’s needs, or exposing them to unsupervised or harmful situations. Children are often displaced from their homes if their parents are unable to care for them due to addiction, incarceration, or if they are no longer alive. As a result, grandparents are often accountable for raising their grandchildren, and in situations that are frequently sudden and precarious. While the stress of these situations can be overwhelming, many grandparents wouldn’t want their grandchildren with anyone else.

According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio. The United States Census reported that nationwide 2.7 million grandparents are raising grandchildren. Grandparents often assume their role as a caretaker without preparation or warning, and often in the midst of another familial crisis. In this case, they may be assuming the responsibility of a caretaker while simultaneously dealing with the trauma of their own child’s addiction. These complications can make for an onerous transition for the entire family.

The American Society on Aging found that one in five grandparents raising grandchildren lives below the poverty line, and one in four has a disability. These grandparents are forced to navigate uncharted territory as they adopt new financial responsibilities, and stress from grandchildren who are often struggling with emotional trauma and separation anxiety from their parents.

A study published in Children and Youth Services Review was conducted to understand the impact of stress on grandparents raising grandchildren. The study involved 214 grandparent caregivers and 86 other kin caregivers. The researchers summarized that grandparent caregivers faced unique challenges due to guilt, birth parent concerns, and generational gaps. It revealed that grandparent caregivers experienced and higher level of parenting stress compared to other kin caregivers, partly due to their advanced age and lower overall health. Grandparent caregivers also related that financial strain, child behavior concerns, navigating service systems and schools, and problematic relationships with birth parents all contributed to their stress.

Families seeking resources can visit Grandfamilies.org, a national legal resource in support of grand-families both in and out of the child welfare system.


Lee, E., Clarkson-Hendrix, M., & Lee, Y. (2016). Parenting stress of grandparents and other kin as informal kinship caregivers: A mixed methods study. https://www.albany.edu/chsr/Publications/Leeetal2016%20parenting%20stress.pdf

Lent, Jaia Peterson. “Grandparents Are Raising the Children of the Opioid Crisis.” Grandparents Are Raising the Children of the Opioid Crisis | American Society on Aging, www.asaging.org/blog/grandparents-are-raising-children-opioid-crisis.

Public Children Services Association of Ohio. (2019). PCSAO – Factbook. Retrieved May 31, 2019, from http://www.pcsao.org/factbook

US Census Bureau. (2019). The opioid crisis and grandparents raising grandchildren. Retrieved May 31, 2019, from https://www.census.gov/library/stories/2019/04/opioid-crisis-grandparents-raising-grandchildren.html

COVID-19 is Especially Tough on Kids in Need

Children in foster care are highly at risk

Published 4/21/20

Peer Recovery Supporters: Benefits and Best Practices

The approach to treating substance use disorder (SUD) has been changing to be more recovery-oriented. There is a shift from treatment and control of symptoms to treatment focused on approaches that empower the client to maintain long-term recovery.  Peer recovery supporters (PRS), trained individuals with their own recovery experience, are thought to provide significant advocacy and support for individuals struggling with addiction. PRS support and advocate for their clients as they navigate the successes and setbacks of the recovery process.

Some of the advantages of using PRS are that clients paired with PRS:

  • Formed better relationships with their treatment providers and greater utilization of social supports
  • Stayed in treatment longer and reported higher satisfaction with treatment
  • Had reduced substance use and were less likely to relapse

Peer Recovery Supporters, in turn, express that having the opportunity to share their lived experience with addiction and recovery with others helps them to:

  • gain better insight into their own symptoms
  • increase social engagement and
  • improve their sense of life satisfaction

The use of PRS as a component of a recovery-oriented treatment model is showing promise for promoting long-term recovery. It is expected that the use of PRS in SUD recovery will continue to grow, and agencies may need to make additional adjustments to support PRS. Cultivating agency culture to embrace and promote the inclusion of peers in SUD treatment is vital to having a successful PRS program. Further, agencies should consider the expansion of peer occupational growth opportunities as well as professional development efforts that allow PRS to qualify for advanced positions. Considering the PRS as a valued professional member of the SUD treatment team will help maximize their ability to help clients engage in treatment and work toward long-term sobriety.

References:
Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., … Kelly, J. F. (2019). Lived experience in new models of care for substance use disorder: A systematic review of peer recovery support services and recovery coaching. Frontiers in Psychology, 10(JUN), 1–12. doi:10.3389/fpsyg.2019.01052
Ahmed, A. O., Hunter, K. M., Mabe, A. P., Tucker, S. J., & Buckley, P. F. (2015). The Professional Experiences of Peer Specialists in the Georgia Mental Health Consumer Network. Community Mental Health Journal, 51(4), 424–436. doi:10.1007/s10597-015-9854-8
Chapman, S. A., Blash, L. K., Mayer, K., & Spetz, J. (2018). Emerging Roles for Peer Providers in Mental Health and Substance Use Disorders. American Journal of Preventive Medicine, 54(6S3), S267–S274. doi:10.1016/j.amepre.2018.02.019