In Maine, as across the nation, within the context of an ever-changing, headline grabbing, and poorly understood pandemic, we are simultaneously facing the continuation of a growing and increasingly well understood epidemic of substance use disorder (SUD). What makes this moment unusual and complicated is the interaction between the two. For those living in recovery, or struggling with an active SUD, the challenges around everyday issues – loss of employment, housing or transportation; access to treatment, support services or counseling; separation from family and community members; battling stigma in all of these areas – have only been exacerbated during COVID-19.
In the best of times, maintaining the delicate balance of recovery is a challenge. Coronavirus is a disruptor that can push people to start using again, or using more. The opioid epidemic impacts everyone in Maine, and for members of any marginalized community, including Black, immigrant, Native American, homeless, LGBTQI+, disabled, or low-income, this issue is only amplified. In fact, COVID-19 should be considered another thread in an already complex web. The existing and ongoing public health crisis of mounting health disparities, rooted in systemic racism, has worsened during the pandemic.
The SUD epidemic is more than opioids. It includes alcohol, marijuana, and other substances such as methamphetamine, cocaine, and benzodiazepines taken separately, or in combination. We now define SUD as a brain disease, and, moreover, a chronic relapsing condition. We also better understand that SUD is often rooted in trauma and adverse childhood experiences (ACES), and worsened with a coexisting mental health issue.
We cannot allow our collective attention to be distracted by the noise of the world – not when overdose rates, substance use, and behavioral health needs are all increasing. There is a critical need for a collective refocusing and understanding of the impact the pandemic is having on those in recovery, those in need of treatment, and for everyone else whose coping mechanisms are failing in the face of extended uncertainty and stress. The reality is that anyone can develop a SUD, struggle to find their path to recovery – and can succumb to relapse. Of equal importance is the need for basic compassion: all too often, or perhaps more accurately when considering SUD – usually the case – the collective societal response is one of criticism and judgement, blame and shame. Our critical role is to join together to ensure that adequate access to treatment and ongoing recovery services and supports are in place, while also focusing on prevention and education. Maine has had some success to date, greatly due to the collaborative efforts led by the state, but we are still far from the end of the SUD epidemic and cannot become complacent, particularly within the context of the broader pandemic. Nor can we expect that the SUD epidemic will end because of some magic pill or the appearance of a single hero.
A friend related a story to me a couple of years ago: her then 8-year old son had observed that there were plenty of good people walking among us; though we often are mistakenly looking for a hero in a cape to do great things. In reality, ordinary people do extraordinary things during any given day. The wisdom of these words is personified in the recent, tragic loss of Jesse Harvey, who died of a suspected overdose. Jesse, a harm reduction leader and advocate, was compassionate and supportive and whose work created quiet miracles. Jesse’s work was a potent reminder to us that people who face daily barriers related to illness and addiction are still able to achieve amazing things; to think beyond their own needs; to reach out to others with a hand, a smile, and an understanding heart. Each person’s unique struggle with SUD needs to become a collective struggle. Despite the work already being done, overdoses are increasing, and it is getting more challenging to enter and to remain in recovery. We need to band together to turn this around.
Since 2016, MeHAF has been working to expand access to SUD services as part of its larger efforts to support an integrated and comprehensive behavioral health system in Maine. There remains a long road ahead, and, if we are to be successful, we must all work together on creating the many small miracles that will get us there.