In January of 2020, the first case of COVID-19 was reported in the United States. Since then, the U.S. has recorded 33 million cases and more than 500,000 deaths related to COVID-19. The novel Coronavirus has not just created a worldwide pandemic, it has also exacerbated an already existing public health crisis in this country: The opiate epidemic.

Over the last two decades, overdose deaths continuously climbed every year from less than 20,000 in 1999 to around 70,000 recorded deaths in 2017. Then, the numbers finally seemed to reach a plateau in 2018 and 2019. However, in 2020, over 81,000 Americans lost their lives as a result of overdoses, which is a sharp increase compared to the 69,000 deaths recorded just 12 months prior. The 2020 figure is the highest number ever recorded. Unfortunately, the predicted numbers indicate that next year’s figures will be even higher.

On the one hand, the COVID-19 pandemic has created isolation, stress, and fear, which are known drivers of substance use behaviors. On the other hand, treatment providers and mutual help groups had to move many of their services to telehealth to follow public health recommendations. However, help is still out there. If you struggle with addiction and want help or you know someone that does, you can contact the Franklin County Alcohol, Drug, and Mental Health (ADAMH) Board at 614-224-1057 or go to https://adamhfranklin.org/.

Peer supporters are people who have been successful in the addiction recovery process. They are trained to provide for people struggling with addiction, mental health, or any form of trauma, a crucial aspect for one’s recovery process. Peers offer an emotional connection that is necessary to prevent feelings of isolation from the person struggling. However, the supporter’s role can be emotionally taxing on its own, and it is not uncommon for a supporter to develop what is known as vicarious trauma.

Vicarious trauma, also known as secondary trauma, is the gradual change or disruption of feelings/emotions, inner thoughts, beliefs and spirit as a result of working with people with traumatic experiences or stories. Secondary trauma is commonly noted among mental health professionals, social workers and those who work closely with traumatized people, including peer recovery supporters.

When a person is actively engaged in helping someone who has experienced trauma, the line between empathy and vicarious trauma is likely blurred, leading to feelings of helplessness, exhaustion and guilt, as well as deliberate avoidance of the individual being supported. For peer supporters in particular, this exposure could lead them to re-experience their own past trauma or experience relapse with alcohol or drug addiction.

Repeated exposure to secondary trauma can create a disconnect between the trauma survivor and the peer supporter if the relationship is not properly maintained. However, there are resources available to build and maintain resiliency in relationships with clients. Peers can consult their hiring agencies for ongoing support and have discussions that promote optimism. Friends and family can utilize online resources such as the Safe Coping Skills worksheet and the Trauma-Informed Care Implementation Resource Center, which offers various free resources from trauma-informed care experts regarding the impact of trauma on health and methods to improve patient outcomes and navigate one’s own trauma.

Peer recovery supporters experiencing vicarious trauma can also practice self-care, both through individual coping strategies, such as proper exercise and sleep, and organizational commitments, including scheduling self-care groups, consulting outside facilitators to manage group sessions, hosting stress-reducing and bonding activities and frequently assessing a staff member’s self-care needs.

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.

In a time of stay-at-home orders, heightened financial stress, and a lack of in-person resources that usually exist, incidents of child maltreatment and domestic abuse are increasing while reported cases are falling. Children are not receiving access to educators, who are often the front-line defense in keeping children safe. Child welfare workers are scrambling to ensure that children continue to receive the care they need despite the desperate circumstances.

An article by USA Today reported that educators including teachers, administrators, and counselors report about one in every five claims of child mistreatment. With children sequestered to their homes and limitations placed on who can visit them, reporting a case of mistreatment is becoming a task that is more precarious than ever. While child caseworkers are limiting visits to their clients’ homes for fear of spreading the virus, they will not become absent from these children’s lives.

Welfare officials are adapting to the virtual environment and setting up video calls to do walkthroughs of children’s home environments. They are also arranging in person visits with higher risk cases, or children who may be in immediate danger. These cases may be addressed through visits in the child’s backyard.

Parents are also facing heightened stress as they learn to manage 24/7 childcare, whether they are working remotely and/or are required to go into the office as essential workers. According to USA Today, “Calls to the group’s National Parent Helpline for families in crisis have spiked 30% in the past week, Pion-Berlin said. They’re coming from mothers and fathers stressed about child care, food insecurity and other fears arising from the coronavirus crisis.”

The Columbus Police Department has also seen an “alarming increase” of domestic violence calls since the stay-at-home order has been in place.

If you are dealing with a difficult home environment, you are not alone. Here are some resources that are available and ready to help during this time of crisis:

Franklin County Children Services Child Abuse Hotline: 614-229-7000

Ohio Domestic Violence Network

CAP4KIDS

National Child Abuse Hotline: 800-422-4453

In 2019, a New York Times reporter, Dan Levin, detailed the horrific experiences of children in Ohio who were removed from their homes after years of neglect, abuse and traumatic childhood experiences. He leads the story by writing that, “Nearly 27,000 children in Ohio were removed from their homes last year, many because of the opioid crisis. More than a quarter were placed in the care of relatives.”

The stories Levin recounted were those of children sent outside without sufficient food and water while their parents use drugs, as sister and brother Hannah and James experienced each summer. These children were also exposed to traumatic violence between their parents, as seven-year-old Hannah called 911 after her mother chased her father with a knife. Hannah’s father was later killed by her mother’s boyfriend.

Stories like these paint the picture of the lives of many of these 27,000 children. Parents in rehab, sick or dead from drug addiction are circumstances that young children are exposed to far too commonly. So commonly, that a name was dedicated to children trapped in these vicious cycles of addiction – Generation O.

Certain geographic areas are more dense with these concerns.

“In Portsmouth, Ohio, at least a quarter of the school district’s nearly 650 junior high and high school students have a close relative who uses drugs.”

As written in another NYT article by Dan Levin, this will have a long-lasting impact on the communities with heavy users, as more children are being born with a dependency on opioids, and many with severe learning disabilities and other types of disabilities. This poses a new challenge for educators as schools increasingly become places of refuge in the lives of maltreated children.

“Many students frequently come to school wearing the same, unwashed clothes days in a row, so shelves are stocked with clean garments, along with fresh shampoo, bars of soap and deodorant.

Yet some of the teenagers change back into their own clothes after the final bell rings and the last class ends, ‘because parents will take new clothes and sell them for drug money,’ said Drew Applegate, an assistant principal.”

In a sobering reality of family life in Portsmouth, an art teacher cannot think of any student who paints a two-parent family during their family portrait lesson.

As long as the opioid crisis presides over these communities, there will continue to be a shift that emphasizes the role of educators in children’s lives.

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.

Children in foster care are highly at risk

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

Research from the U.S. Census Bureau has found that states with higher opioid prescribing rates have higher numbers of grandparents raising grandchildren, even after taking into account other socio-economic factors such as poverty. Data from the 2012-2016 American Community Survey allowed researchers to study the relationship between opioid prescription rates at the state and county level and the number of grandparents raising grandchildren. The study found that opioid misuse was involved in 46% of cases where grandparents are caring for grandchildren in rural areas, compared to 32% in urban areas. Nationally, 32% of children in foster care are being raised by relatives with many more are being raised by relatives outside of the foster care system. Currently, 2.7 million grandparents are raising grandchildren. According to the Public Children Services Association of Ohio, about 100,000 grandparents are currently raising their grandchildren in Ohio.

Ohio is making progress in reducing its opioid prescribing rates, but rates are still high. Since 2010, Ohio’s overall opioid prescribing rate has dropped from 102.4 to 63.5 per 100 persons, which is still higher than the national rate of 58.7. Cuyahoga is the only urban county, at 50.1 per 100 persons, have an opioid prescribing rate lower than the national rate. In rural counties, the prescribing rate ranges from Nobel the lowest (17.8) to Jackson the highest (112.5). Ohio continues to be challenged by the misuse of opioids with the second-highest opioid overdose death rate of 39.2 deaths per 100,000 persons.

Grandparents raising grandchildren face many special challenges including mental health concerns for themselves and their grandchildren due to the death or temporary loss of their grandchild’s parent (their son or daughter), financial obligations, navigating the school system, and building networks of social and other supports. To respond to the impact of the opioid crisis on grandparents, the federal government enacted The Supporting Grandparents Raising Grandchildren Act in July of 2019. The act created a federal task force to identify and share information to help grandparents raising grandchildren.

Anderson, L. (2019). The opioid prescribing rate and grandparents raising grandchildren: State and county-level analysis. Retrieved from https://www.census.gov/content/dam/Census/library/working-papers/2019/demo/sehsd-wp2019-04.pdf

Centers for Disease Control and Prevention. (2017). U.S. Opioid Prescribing Rate Maps | Drug Overdose | CDC Injury Center. Retrieved May 31, 2019, from https://www.cdc.gov/drugoverdose/maps/rxrate-maps.html

Cole, P. E., Clausen, K. A., Cook, L., Johanson, M., Cunliffe, J., Associate, R., Rostan, M. (2016). 2016 state of poverty: A portrait of Ohio families. Retrieved from www.oacaa.orgwww.researchpartners.org

National Institute on Drug Abuse (NIDA). (2019). Opioid summaries by state. Retrieved May 31, 2019, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-summaries-by-state

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

Good Samaritan laws are meant to protect someone from legal liability when providing help to a person in distress. Ohio has had a Good Samaritan Law since 1977 to protect people from malpractice lawsuits when providing emergency medical and non-medical care to someone in need. This protection is not just for off-duty medical professionals but also for any citizen. This law does not protect someone who deliberately acts in a way that they know can cause further harm, or who accepts money, gifts, or any form or payment for helping.

Do you have to help someone in distress? Ohio does have a “duty to rescue” rule and requires you to help someone in distress if:

• You are responsible for the welfare of a child. This includes parents, guardians, teachers, and any adult responsible for the child.
• Your actions caused the danger.
• You started to help – you must continue to help unless the situation changes to put you in danger.

In 2016, Ohio revised its Good Samaritan laws (Ohio Revised Code Section 2925.11) to encourage people to call 911 when they see someone who overdoses. What this law does is provide immunity for minor drug possession, amounts considered to be a misdemeanor or fifth-degree felony, to individuals who seek emergency help for themselves or another person during a drug overdose. The 911 operator receiving the overdose call can help explain this immunity if asked. You cannot be arrested or prosecuted if:

• Law enforcement found the drugs as a result of seeking medical assistance for a drug overdose.
• The person has a drug test and receives referral for treatment from an accredited addiction treatment program or professional within 30 days.
• The person provides documentation, when requested by a prosecutor, verifying the date and time of the drug test and receiving the referral.

This immunity can be used twice and people on parole or probation are not eligible. The immunity is limited to possession of controlled substances. House Bill 205 is currently in the Ohio Legislature and, if approved, it will expand immunity to include drug paraphernalia.