Data from PA: Opioid Overdoses Escalated During Covid Lockdown

Data from PA: Opioid Overdoses Escalated During Covid Lockdown

Since the first diagnosed case of COVID-19 in the United States on Jan. 20, 2020, news about infection rates, deaths and pandemic-driven economic hardships has been part of our daily lives. 

But there is a knowledge gap in how COVID-19 has affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died every day from an opioid overdose. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.

Originally published in The Conversation - USE THIS LOGO

We are a team of health and environment geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns might result in a spike in opioid overdose and deaths. In our latest research in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania prior to and following the statewide stay-at-home order.

Our findings suggest that this public health response to COVID-19 has had unintended consequences for opioid use and misuse.

History of the Opioid Epidemic

Opioid misuse has been a major U.S. health threat for over two decades, largely affecting rural areas and white populations. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has resulted in an expansion of the epidemic in urban areas and among other racial and ethnic groups

From 1999 to 2013, increasing death rates from drug abuse, primarily for those from 45 to 54 years of age, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.

There was a modest national decline in overdose mortality from prescription opioids from 2017 to 2019, but the COVID-19 pandemic has upended many of these advances. As one of our public health partners explained to us, “We were making progress until COVID-19 hit.” 

We believe this presents an urgent need for research on the relationships between COVID-19 policy responses and patterns of opioid use and misuse.

Opioid Use Increased During the Pandemic

Pennsylvania has been among the states hardest hit by the opioid epidemic. It had one of the highest rates of death due to drug overdose in 2018, with 65%, a total of 2,866 fatalities, involving opioids.

The state’s stay-at-home order, implemented on April 1, 2020, mandated that residents stay within their homes whenever possible, practice social distancing and wear masks when outside the home. All schools shifted to remote learning, and most businesses were required to operate remotely or close. Only essential services were allowed to continue operating in person.

In the following months, the public’s overall cooperation with these mandates contributed to measurable declines in coronavirus infection rates. To learn how these mandates also affected people’s use of opioids, we assessed data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid-related overdose before and after April 1, 2020. We also examined the change by gender, age, race, drug class and doses of naloxone administered. (Naloxone is a drug widely used to reverse the effects of overdose.)

Our analysis of both fatal and nonfatal cases of opioid-related overdose from January 2019 through July 2020 revealed statistically significant increases in overdose incidents for both men and women, among whites and Blacks, and across several age groups, most notably the 30-39 and 40-49 groups, following April 1. This means there was an acceleration of overdoses within some of the populations most affected by opioids prior to the COVID-19 pandemic. But there were also uneven increases among other groups, such as Black people.

We found statistically significant increases in overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids and carfentanil. This is consistent with previous research on the main opioid classes contributing to increases in drug overdose and death. The results also affirm that heroin and synthetic opioids such as fentanyl are now the major threats in the epidemic. 

When a Pandemic and an Epidemic Collide

While we found significant change in opioid overdoses during the COVID-19 pandemic, the findings say less about some of the driving factors. To better understand these, we have been interviewing public health providers since December 2020. 

Among the important factors they highlight as contributing to increased opioid use are pandemic-driven economic hardship, social isolation and the disruption of in-person treatment and support services.

From March to April 2020, unemployment rates in Pennsylvania shot up from 5% to approximately 16%, resulting in a peak of more than 725,000 unemployment claims filed in April. As workplace shutdowns made it harder to pay for housing, food and other needs, and the opportunities for in-person support disappeared, some people turned to drugs, including opioids.

People in the early stages of treatment or recovery from opioid addiction may be particularly vulnerable to relapse, suggested one of our public health partners. “They might be working in industries that are closed down, so they have financial problems … [and] they have their addiction issues on top of that, and now they can’t like go to meetings, and they can’t make those connections.” (Under our clearance with Penn State for doing research with human subjects, our public health informants are kept anonymous.)

An addiction treatment counselor told us that especially for those with past or present opioid use problems, or histories of mental health issues, “It’s not a good thing to be alone in your own thoughts. And so, once everybody was kind of locked down … the depression and anxiety hit.”

Another counselor also pointed to depression, anxiety and isolation as driving increased opioid misuse. The pandemic “just spun everything out of control,” they said. “Overdoses up, everything up, everything.”

One question is whether states like Pennsylvania will continue to support telehealth in the future. While the transition from in-person to telehealth services has increased access to treatmentfor some, it has raised challenges for populations like the rural and elderly. As one provider explained, “it’s really hard for that [rural] population out there” to utilize telehealth services due to limited internet and broadband connection. In other words, flexible modes of addiction treatment might work for some but not others.

The goal of our research is not to criticize efforts to mitigate the spread of COVID-19. Without the mandatory stay-at-home order in Pennsylvania, both infection and death rates would have been worse. However, our research shows that such measures have had unintended consequences for those struggling with addiction and emphasizes the importance of taking a holistic approach to public health as policymakers work to confront both COVID-19 and the addiction crisis in America.

Vaccination, American Style: A “Crazy Quilt” of Policies

Vaccination, American Style: A “Crazy Quilt” of Policies

In North Carolina, the nation’s leading tobacco producer, any adult who has smoked more than 100 cigarettes in their lifetime can now be vaccinated against covid.

In Florida, people under 50 with underlying health conditions can get vaccinated only if they have written permission from their doctor.

In Mississippi, more than 30,000 covid vaccine appointments were open Friday — days after the state became the first in the contiguous United States to make the shots available to all adults.

In California — along with about 30 other states — people are eligible only if they are 65 or older or have certain health conditions or work in high-risk jobs.

How does any of this make sense?

“There is no logical rationale for the system we have,” said Graham Allison, a professor of government at Harvard University. “We have a crazy quilt system.”

Jody Gan, a professional lecturer in the health studies department at American University in Washington, D.C., said the lack of a national eligibility system reflects how each state also makes its own rules on public health. “This hasn’t been a great system for keeping, you know, the virus contained,” she said.

The federal government bought hundreds of millions of doses of covid vaccines from Pfizer, Moderna and Johnson & Johnson — as well as other vaccines still being tested — but it left distribution largely up to the states. Some states let local communities decide when to move to wider phases of eligibility.

When the first vaccines were cleared for emergency use in December, nearly all states followed guidance from the federal government’s Centers for Disease Control and Prevention and restricted use to front-line health workers and nursing home staffs and residents.

But since then states have gone their own way. Some states have prioritized people age 75 and older, while others have also allowed people who held certain jobs that put them at risk of being infected or had health conditions that put them at risk to be included with seniors for eligibility. Even then, categories of jobs and medical conditions have varied across the country.

As the supply of vaccines ramped up over the past month, states expanded eligibility criteria. President Joe Biden promised that by May 1 all adults will be eligible for vaccines and at least a dozen states say they will beat that date or, as in the case of Mississippi and Alaska, already have.

But the different rules among states — and sometimes varying rules even within states — created a mishmash. This has unleashed “vaccine jealousy” as people see friends and family in other states qualify ahead of them even if they are the same age or have the same occupation. And it has raised concerns that decisions on who is eligible are being made based on politics rather than public health.

The hodgepodge mirrors states’ response overall to the pandemic, including wide disparities on mask mandates and restrictions for indoor gatherings.

“It’s caused a lot of confusion, and the last thing we want is confusion,” said Harald Schmidt, an assistant professor of medical ethics and health policy at the University of Pennsylvania.

As a result, some Americans frantically search online every day for an open vaccine appointment, while vaccines in other states go wanting.

The assorted policies have also prompted thousands of people to drive across state lines — sometimes multiple state lines — for an open vaccine appointment. Some states have set up residency requirements, although enforcement has been uneven and those seeking vaccines are often on the honor system.

Todd Jones, an assistant professor of economics at Mississippi State University near Starkville, said the confusion signals a need for a change in how the government handles the vaccine. “The Biden administration should definitely be thinking about how it might want to change state allocations based on demand,” Jones said. “If it does become clear that some states are actually not using lots of their doses, then I think it would make sense to take some appointments from these states to give to other states that have higher demand.”

Jagdish Khubchandani, a professor of public health at New Mexico State University, said no one should be surprised to see 50 different eligibility systems because states opposed a uniform federal eligibility system.

“Many governors don’t want to be seen as someone who listens to the federal government or the CDC for guidance,” he said. Florida Gov. Ron DeSantis, a Republican, has boasted of ignoring the CDC advice when he opted to make anyone 65 and older eligible beginning in December.

“There is a lot of political posturing in deciding eligibility,” Khubchandani said.

To be sure, governors also wanted the flexibility to respond to particular needs in their states, such as rushing vaccines to agricultural workers or those in large food-manufacturing plants.

Jones said the decision to open vaccines to all adults in the state may sound good, but Mississippi has one of the nation’s lowest vaccination rates. Part of that is attributed to hesitancy among some minority communities and conservatives. “It’s good news everybody can get it, but there doesn’t seem to be a whole lot of demand for it.”

Jones, 34, was able to go online for a shot on Tuesday and was vaccinated at a large church a short drive from his home on Thursday morning. “I was very happy,” he said.

Published courtesy of KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Nurse of the Week: BSN Student/Entrepreneur Anthony Scarpone-Lambert Shoots for the Moon

Nurse of the Week: BSN Student/Entrepreneur Anthony Scarpone-Lambert Shoots for the Moon

Tending to a sleeping patient in a dark room is like navigating a cartoon-style obstacle course. You could experiment with all sorts of awkward maneuvers, contortions, perhaps even juggling. At the end of your experiments, you’d probably conclude that even if it is not impossible, working in the dark sets the scene for a host of mishaps and errors that can endanger your patients. So, most night shift nurses turn on the lights in a patient’s room an average of nine times an evening. Nurse of the Week Anthony Scarpone-Lambert, a 21-year-old nursing senior at the University of Pennsylvania , and Johnson & Johnson Nurse Innovation Fellow, Jennifferre Mancillas, RN, BSN, RNC-NIC decided to devise a way to help nurses work in the dark without disturbing patients’ slumber times.

Scarpone-Lambert's partner, Jennifferre Mancillas
Jennifferre Mancillas partnered with the U Penn Senior.

Scarpone-Lambert and Mancillas, who met at the 2019 Johnson & Johnson nurse hackathon, surveyed 250 nurses and learned that 87% of them have trouble seeing during those night-time visits. “When nurses can’t see, we put our patients and ourselves at risk. This leads us to turn on intrusive overhead room lights that disrupt our patients,” Mancillas elaborated for the Philadelphia Inquirer. Such sudden awakenings deprive patients of much-needed rest, and can slow recovery. The innovative pair came up with a solution: the uNight Light, a wearable 2×1-inch LED light.

Two nurses model the uNight Light created by Scarpone-Lambert and Mancillas

The nurse-entrepreneurs describe their invention as “The first-ever wearable LED light made specifically for frontline healthcare workers, allowing you to illuminate your workspace while decreasing patient sleep disturbances by 70%.” They add, “Inspired from the military, our device comes with three light settings [white, blue, and red] to optimize your ability to care for patients and remain alert. uNight Light’s brightness has been tested to give the perfect balance of illumination; keeping you safe and your patients asleep.”

Other nurses have essayed hacks of their own. As one NP related to the New York Times, “I had a co-worker who would wear those night lights that runners use on his forehead,” but the Forehead Night Nurse Light, alas, was not a runner, and lacked legs. The uNight Light, however, has some ardent supporters.

As for Scarpone-Lambert, his instructors, the J&J judges, and SONSIEL’s Rebecca Love, co-editor of The Rebel Nurse Handbook—which was awarded third place in the 2020 AJN Book of the Year Awards in Professional Issues—all seem to agree that the U Penn senior is going places. Bobbi Martin, president and CEO of the Global Nurse Foundation, said, “He just doesn’t quit, and never stops at ‘no’. He gets people excited.” Speaking to the Philadelphia Inquirer, Love, president of the Society of Nurse Scientists, Innovators, Entrepreneurs, and Leaders (SONSIEL), said Scarpone-Lambert stands out for “his drive, character, and passion. And Anthony operates at a different speed, thinking six steps ahead. He is one of the individuals with the potential to be a moonshot in the nursing profession, and I don’t say that lightly.”

Strong words to live up to, but Scarpone-Lambert seems poised to take off even before his pinning ceremony.

[et_bloom_inline optin_id=”optin_97″]

Nurse of the Week Margaret Ruto is also a Part-Time Crime Fighter

Nurse of the Week Margaret Ruto is also a Part-Time Crime Fighter

Now that Kenyan-born Nurse of the Week Margaret Ruto is on the scene, someone should tell Chris Hansen that there’s a new player in the predator-catching business. One day in 2017, while working toward her nursing degree in Lancaster, Pennsylvania, Ruto came across a Facebook post about the closing of a children’s home near her old village in Kenya. The missionary who had run the home, Gregory Dow, fled the country and took shelter… to Lancaster, PA, just 10 minutes away from Ruto’s own house!

Learning that a child abuser had used her village’s children’s home as his personal playpen galvanized her. Between attending classes and studying, Ruto stayed up late to contact authorities: local police. The District Attorney’s office. The State Department. The US Embassy in Kenya. She got nowhere.

The nursing student felt compelled to do all she could to help the youngsters and bring the home’s proprietor/abuser to justice, even if it meant taking time off from school, but fortunately it did not come to that. Still, “I was getting ready to drop out of the [local community college] nursing program to pursue this case,” she told Lancaster Online. “That’s how passionate I was.” In 2018, after classes ended, Ruto flew to Kenya to see her ailing mother-in-law, and began to investigate the situation for herself. Traveling an hour to reach the village where the shuttered children’s home was located, she shuttled to and from the site as she listened to and recorded the survivors’ accounts. According to the Post, “She gained the trust of the abused girls and their parents and took down their gut-wrenching version of events in notepads and videos on her phone.”

The FBI, sped by the evidence that Ruto amassed in her private investigations, was able to wrap up its case against Dow in a few months. In July, 2018, the nurse-detective’s selfless persistence paid off when police arrested Gregory Dow at his home in East Hempfield Township, PA.

For the full, remarkable story about Margaret Ruto and her investigation, see Lancaster Online or read the Washington Post article.

You May Get Your Covid Jab From a Nursing Student

You May Get Your Covid Jab From a Nursing Student

In Texas, Pennsylvania, Tennessee, and many other states, nursing students are saying, “Would you please roll up your sleeve?”

U Tennessee nursing students prepare Covid-19 vaccine doses.

Being a nursing student during a pandemic may be lacking in some respects, but at schools of nursing around the United States, students are helping to save lives and play an historic role. Some are keenly aware of their position. In Philadelphia, PA, Alondra Torregrossa, a nursing junior at Temple University’s College of Public Health , helped vaccinate 250 health workers at the Temple U Hospital as members of the media looked on. She said, “To be there as a student nurse felt like being a part of history,” but added, with a nurse’s passion for accuracy, that “I wasn’t too nervous, because I had a recently done flu shot clinic on the Health Sciences Campus.”

At Temple’s nursing program—like many others—students leapt at the chance to take part and gain more in-person experience with patients. Undergrad program director Joelle Hargraves remarked, “The opportunity for nursing students to participate was priceless. They eagerly volunteered to be part of an interprofessional team and witnessed how nurse leaders formulated and implemented a seamless plan for immunizing essential health care providers.”

“Despite the hospital being inundated with COVID-19 cases, the vaccination clinic is a glimmer of hope.”

University of Connecticut Nursing Student

The University of Connecticut School of Nursing called upon their students as well, and during the first two weeks of January they administered jabs to UConn Health staff and monitored them for adverse reactions. 20 students pitched in, but Dean Deborah Chyun said, “We initially had 85 undergraduate and graduate students express interest in volunteering, as well as a handful of faculty. Due to scheduling, not all were able to participate, but that level of caring speaks volumes about our students.”

In normal conditions, students rarely provide vaccinations even during clinicals, but Covid jab duty is now offers a precious opportunity to practice nursing. For example, “There was one occasion where an individual felt dizzy post-vaccination and required further evaluation,” says Amanda Moreau, a clinical coordinator and instructor with the U Conn School of Nursing. “The student played a crucial role in identifying that the individual did not feel well and initiated the proper protocol to call for additional medical assistance…”

After helping give shots to 200 U Connecticut Health workers, needle-wielding student Rebekah Gerber reflected, “It was easy to get lost in the procedure in the moment, but as I reflect back, I realize that these vaccines will save so many lives. It is an honor to have played a very small role in distributing the vaccines.”

Nursing students at University of Tennessee administered 400 shots in a single day. “They had the chance to talk with patients, answer questions they might have about the vaccine itself or side-effects, and even deal with some folks who might be nervous about getting the injection,” according to Victoria Niederhauser, the UT College of Nursing Dean.

A U Conn nursing student remarked on the experience, “I was often asked to take pictures of individuals receiving their vaccines so they could document their participation in this historic experience and encourage others to receive their vaccines as well. Overall, the environment was positive and uplifting. Despite the hospital being inundated with COVID-19 cases, the vaccination clinic is a glimmer of hope.”

COVID Insouciance Frustrates Frontline Nurses: “People Aren’t Listening to Us”

COVID Insouciance Frustrates Frontline Nurses: “People Aren’t Listening to Us”

As hospitalizations and deaths mount, nurses are losing patience with COVID-19 conspiracy theories and distorted libertarian mores that depict masking mandates as an infringement of personal liberty.

As Covid surges, nurses are becoming frustrated by anti-maskers and conspiracy theorists.

For frontline nurses tending to Covid patients who shunned masks or insisted on attending crowded gatherings, the situation is fraught with tragedy. South Dakota ED nurse Jodi Doering recently told CNN , “I think the hardest thing to watch is that people are still looking for something else and a magic answer and they do not want to believe Covid is real. Their last dying words are, ‘This can’t be happening. It’s not real.’” In North Dakota, Governor Doug Burgum pleaded, “You don’t have to believe in Covid, you don’t have to believe in a certain political party or not, you don’t have to believe whether masks work or not. You can just do it because you know that one thing is very real. And that’s that 100 percent of our capacity is now being used.”

“I want you to listen to health care providers and [what] your officials are telling you. I don’t want praise and I certainly don’t want to be your martyr.”

Tiffany M. Montgomery, PA Frontline Nurse

Nebraska ICU nurse Laci Gooch spoke out in a Twitter video: “We’re tired. We’re understaffed. We’re taking care of very, very sick patients and our patient load just keeps going up. We’re exhausted and frustrated that people aren’t listening to us.” Driving home after one night shift, Gooch passed a car festival packed with attendees blithely ignoring masking and social distancing, and “I was just shocked and it was infuriating. It just kind of feels like a slap in the face to all the hard work that we’re doing.”

Kentucky nurses, too, are “tired and frustrated” by the neglect of social distancing rules. Delanor Manson, of the Kentucky Nurses Association, told WLKY, “Some of the things that make it especially hard for [frontline nurses] is that they can’t get the vision of people dying out of their heads when they’re sleeping at night and when they’re at home with their families.”

There is irony as well. Despite being acclaimed as “healthcare heroes” around the globe, nurses feel doubly vulnerable when they go home to communities that frown on masking. “Wearing a mask won’t hurt you, but there’s the potential if you don’t wear a mask you may hurt someone else,” said Dr. Ruth Carrico, an infectious disease nurse and researcher with University of Louisville Health in Kentucky. In Pennsylvania, Tiffany M. Montgomery, a Drexel University postdoctoral research fellow who also works as a labor and delivery nurse, told the Morning Call, “I had no idea we would be doing it for this long and I’m just tired. I don’t want to be your superhero. I want to be safe. I don’t want to have to deal with this anymore. I want you to listen to health care providers and [what] your officials are telling you. I don’t want praise and I certainly don’t want to be your martyr.”