How the COVID-19 Pandemic is Contributing to an Increase in Drug Overdose Deaths
Humans are a social species. We are also prone to stress, anxiety, and fear, all of which impact our mental and physical health in ways that we still do not fully understand. So, when a global pandemic strikes that requires us to dramatically change the way we interact, both in our everyday lives and on a broad, societal scale, our collective and individual health is bound to be affected.
Throughout 2020 the SARS-CoV-19 (COVID-19) pandemic has forced Americans to change our lives in a myriad of ways. We have had to decrease physical contact with other humans, including our friends and loved ones. Extra precautions are required every time we leave our homes to help reduce our risk of becoming infected and/or spreading infection. Many of us have experienced the unexpected loss of employment, forcing us to rely on state and federal aid and feel as though we have lost our independence. And nearly all of us have experienced an increase in either fear, anxiety, or stress, or any combination of these emotions, due to social isolation or economic insecurity. This is all to say, 2020 has been a challenging year for all of us.
Unsurprisingly, these challenges have made a profound impact on our individual and societal health. A survey conducted by the Kaiser Family Foundation, a non-profit, non-partisan source on national health-related issues, found in July that 53% of Americans reported negative impacts on their mental health due to worry and stress associated with the pandemic; an increase from 32% in the March survey. (1) Suicide rates are known to increase in times of economic uncertainty and suicide is linked to social isolation its associate, depression. (2) Additionally, reported alcohol sales have increased during the pandemic, including a 55% increase in physical sales for the week of March 21, 2020, and a 253% increase in online sales. (2) And, tragically, death from drug overdose has also increased in the U.S. (3, 4, 5, 6, and 7) On July 15th, 2020, it was reported by The New York Times that they found an average increase of 13% in deaths associated with drug use for this year, as compared to 2019. (3) This figure was calculated using data collected by state and local governments that, according to the authors, represents approximately 40% of the U.S. population.
Of course, there are a multitude of factors playing a role in each one of these issues, making them complex puzzles to solve. One particularly tricky puzzle, and the focus of this post, is the rise of deaths associated with drug use. Government officials, health care providers, addiction treatment professionals, and researchers of all sorts have sought the solution to this puzzle for years, especially since the late 1990’s when opioid pain relievers were made more easily accessible through a variety of mechanisms. Perhaps the most publicized of these mechanisms is the way in which pharmaceutical companies intentionally misled medical professionals by downplaying the addictive potential of said drugs. (8) Purdue Pharma LP (the makers of OxyContin) and the connected Sackler family have famously battled lawsuits alleging their role in contributing to the opioid crisis on the national stage for multiple years. (9)
However, the opioid crisis isn’t solely the fault of any one entity, not even the manufacturers. It is, in fact, a result of an interconnected web of factors within our society that is far too vast to analyze within this post. That said, many of these factors can be examined with a question I believe to be extremely important: “Do we live in a healthy society?” To understand why this question is so relevant, we must examine an old study, one affectionately named Rat Park.
In the 1960s, researchers studied drug addiction by experimenting on lab rats. Famously, rats were placed in operational conditioning chambers, also known as Skinner boxes (named for their creator B.F. Skinner), which were tiny, stimulus-free rooms that rats would be placed in and observed. There would also be two levers in the box, one that would provide water if pressed, and one that would deliver an injected dose of a drug of interest. (10, 11, 12) These tests were done with a variety of substances, including opioids, and the results showed consistently that the rats would repeatedly press the lever that led to receiving a dose of the drug, often to the point of death via overdose. A surface-level analysis of these results would logically conclude that each drug associated with these results must be dangerously addictive. In fact, this was the accepted conclusion nationwide. (10, 11, 12) However, this conclusion neglects to consider the environment in which these rats were choosing to abuse drugs.
The Skinner box is a psychologically torturous place. It is defined by extreme isolation and a lack of stimuli on par with solitary confinement. The rats in these studies had nothing to occupy their time with aside from pressing one of two levers and receiving either water or a narcotic. It is reasonable to think that, in the absence of any other remotely fulfilling option, the rats would choose cocaine or morphine over water. Almost any living organism with the freedom of choice is going to choose a psychoactive substance over water when it is trapped in a featureless box and has nothing else to do. Yet, this conclusion was not considered by the researchers. However, while those who concluded that these drugs were innately harmful or addictive either failed to recognize or chose to ignore the potential of environmental factors on the study outcome, psychologist Bruce K. Alexander did not. (10, 11, 12)
In the late 1970s, Alexander and his colleagues at Simon Fraser University in British Columbia, Canada, had another experiment in mind. They wanted to conduct the same test, but with rats living in an environment closer to that of their natural habitats. So, the team built a large box in their lab that was designed to provide a healthy environment for the rats. They included wood chips, climbing platforms, tin cans, and other items for hiding, and exercise wheels then filled the area with male and female rats. (10, 11, 12) The environment was much more conducive to the rats’ natural way of life. In Rat Park, they were able to play, socialize, mate, and relax. When provided with the same choice between water and one of several narcotics, the results were much different than for rats kept in Skinner boxes (which the team also recreated for comparison). The rats of Rat Park unanimously opted for water more often than the drugs and there were no incidents of overdoses. While living in Rat Park, a place where the rats’ basic needs were met, they abused drugs less often and used them more safely. (10, 11, 12)
Rat Park’s findings are some of the most important in the field of drug addiction research. It highlights, specifically, the importance of societal health and its relation to drug abuse. Rats, like humans, are social creatures. The isolation and lack of stimuli experienced within Skinner boxes drove rats to abuse drugs to the point of death. This shows how incredibly important it is that our environment and our society are constructed with our mental health in mind. When our needs are met, or we are provided with ways to meet them, we are less likely to engage in unhealthy behaviors such as drug abuse. Of course, there are many factors contributing to drug overdose rates in this country. Fentanyl contamination is becoming more common, interruptions to addiction treatment were sudden and widespread early in the pandemic, years of overprescribing opioids has flooded the country with them, the list goes on and on. However, I wanted to highlight Rat Park and the implications of its findings simply because this pandemic has had a profound impact on our environment and societal health.
During this pandemic, we, as a society, have had to temporarily place ourselves in isolation, away from our friends, family, and colleagues and we are dealing with increasing financial instability, depression, anxiety, and many other ill effects. Sadly, the result is a spike in overdose deaths. Data published by a drug policy office within the White House showed that, compared to 2019, the rate of growth for overdose fatalities increased by 11% during the first four months of this year. (4,5)
It is important that we recognize the impact all of this is having on our societal and mental health in order to recognize the gaps between which of our needs are being met and which are not. We can reach out to each other, ask how each other is doing, support each other, and consider the ways in which to improve the systems in place rather than place blame on individuals for the mechanisms in which they choose to cope. In doing so, we can work towards a healthier and happier community.
If you, or someone you know, is struggling with addiction, or any mental health condition, you are not alone. There are plenty of resources available for you.
Find your local NAMI, National Alliance on Mental Illness for Support
There are also AA & NA Meetings being provided online. Some can be found here, or they can be found with a quick online search.
Author: Stephen Vallely | PharmD Candidate 2021 | University of Michigan
Resources
Panchal N, Kamal R, Muñana C, Aug 21 PCP, 2020. The Implications of COVID-19 for Mental Health and Substance Use. KFF. Published August 21, 2020. Accessed September 10, 2020.
Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM. doi:10.1093/qjmed/hcaa202
Katz J, Goodnough A, Sanger-Katz M. In Shadow of Pandemic, U.S. Drug Overdose Deaths Resurge to Record. The New York Times. Published July 15, 2020. Accessed September 10, 2020.
Ehley B. Pandemic unleashes a spike in overdose deaths. POLITICO. Accessed September 10, 2020.
COVID-19 and the opioid crisis: When a pandemic and an epidemic collide. AAMC. Accessed September 10, 2020.
Health M. Millennium Health’s Signals ReportTM COVID-19 Special Edition Reveals Significant Changes in Drug Use During the Pandemic. Millennium Health LLC. Accessed September 10, 2020.
Alter A, Yeager C, Analyst O. COVID-19 Impact on US National Overdose Crisis. :5.
Abuse NI on D. Opioid Overdose Crisis. National Institute on Drug Abuse. Published May 27, 2020. Accessed September 10, 2020.
Where the Purdue Pharma-Sackler legal saga stands - Reuters. Accessed September 10, 2020.
Voyages R. Rat Park — A Guide For Connected Living. Medium. Published June 15, 2018. Accessed September 10, 2020.
Addiction: The View from Rat Park (2010). Accessed September 10, 2020.
What Does “Rat Park” Teach Us About Addiction? Psychiatric Times. Accessed September 10, 2020.
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