COVID-19 took a serious toll on mental health. Increased rates of anxiety and depression meant that more people turned to substances, including opioids, alcohol and other stimulants, to cope. In fact, every state in the U.S. has reported an outbreak or steady increase in drug-related deaths. According to Centers for Disease Control and Prevention, more than 107,000 drug-related deaths were reported in the U.S. from January 2021 to January 2022.
Three years after the start of the pandemic, people are still turning to substances to cope with stress and anxiety. Dr. Stephanie Newby, addiction psychiatrist with Atrium Health, explains the physical effects of these addictions and describes the negative feelings people are facing. She also shares effective treatments and strategies for recovery – with a focus on hope.
Physical Effects of Addiction
Since the pandemic, Newby has seen the consequences of increased substance use become more visible.
“I’m seeing more patients in their 30s, 40s and 50s coming in with organ disease from substance use behaviors that they picked up or accelerated during the pandemic,” she says. “It’s very tragic that organ damage and failure seem to be happening so fast, especially with alcohol use.”
Alcohol
Newby is seeing more patients receive treatment for late-stage liver disease or being evaluated for an organ transplant.
“Patients will say, ‘I never even thought that alcohol was a problem. I know my drinking increased during the pandemic, but I see people drinking more than I do. Everything was fine until a month ago, when I started to look yellow and my legs started swelling.’ Their condition may be so bad that there’s no opportunity to change their behavior before they need a life-saving procedure or experience death.”
Fentanyl
Fentanyl has replaced heroin in popularity in the opioid category of drugs. It’s now available as pressed pills for people who don’t want to inject it into their veins. Fentanyl is 50 times more potent than heroin and commonly leads to overdose.
“Our brain circuitry is so powerful,” Newby explains. “Once the opioid gets into your system, it drives your behavioral choice and makes it very difficult to stop taking the drug. Each time you use, you’re strengthening that addictive brain circuitry.”
Unfortunately, fentanyl is often contaminated with other substances. This is because dealers often cut the drug with other substances and don’t follow sterile procedures during processing. Possible contaminants include bacteria, fungus, starches, chemical residues and metals.
“About 95% of what people are injecting into their bodies is contaminated,” says Newby. “It’s important to remember that what you inject into your bloodstream flows into the heart. I’m seeing more patients with life-threatening bacterial, fungal and viral infections caused by contaminated fentanyl.”
Bacterial infections tend to concentrate in the heart, skin and spinal cord. Fungal infections tend to affect the heart and brain. Viral infections, including HIV and hepatitis C, are associated with intravenous (injected into the veins) illicit substance use.
Treatment for these conditions is available and effective but can't be administered to patients with active substance use disorders. In addition, treatment tends to be hard on the body. For example, the medications used to treat fungal infections are more damaging to the liver and kidneys than common antibiotics.
Cannabis
Newby has seen cannabis act as a gateway drug for many of her patients.
“Especially in younger patient populations, 98% of cases of illicit drug users started out using cannabis,” she notes. “The problem is that cannabis use initiates the addictive brain circuitry. It starts this belief that altering your consciousness is helpful in regulating your thinking. But altering your consciousness is really a dysfunctional way to treat stress and anxiety. It’s putting you on a dangerous path to addiction that will alter the course of your life.”
Recent U.S. surveys of adolescent substance use show an increase in use following the release of COVID-19 social restrictions. According to the data, a secondary factor is the relaxation of parental supervision and home monitoring.
Newby has seen patients with cannabinoid hyperemesis syndrome (a condition that causes severe nausea and vomiting), cannabis overdoses and random neurological complications from cannabis use. She has treated young patients who were smoking cannabis while pregnant in order to treat morning sickness and sleep issues. However, research studies show the negative effects of cannabis on unborn babies, including reductions in birth weight and delayed neurological milestones in infancy.
Newby emphasizes how substance use disorders shorten life expectancy. “The consequences are not purely mental or psychiatric; they’re physical and biologic,” she says. “Unfortunately, those consequences can’t be altered. The ingestion of poisonous substances damages your body.”
Mental Health Challenges
According to Newby, people’s mental health is worse than ever, mostly because of the unraveling of the social network caused by the pandemic.
“Social support structures, such as churches and community gatherings, ended abruptly, giving us fewer opportunities to reach out to others for help during the pandemic,” Newby says. “People got out of the habit of going to church or community gatherings. So now it’s harder to get motivated because they haven’t been going.”
Even after the pandemic, many people are still working from home and coping with social isolation. This gives employees fewer opportunities to discuss negative emotions with coworkers. It’s also much easier to access substances throughout the day and away from others.
In addition, Newby recognizes the negative world view that’s common, particularly among young people.
“They look at the discord in our political system, the ever-changing global climate and systemic racism, and they feel like they’re not going to have the same opportunities that the older generations had,” she explains. “The standards of the American dream are sort of falling apart. Many young people have lost hope.”
Treatment and Support
On a positive note, there are improved regulations for substance use medications and effective treatment options available throughout the community.
Revised Regulations for Medications
The U.S. government has improved regulations for the medications used to treat patients with treatment-resistant opioid use disorder. These medications include methadone and buprenorphine. They are proven to save lives by reducing use, overdose deaths and the incidence of life-threatening infections.
Previously, there were several barriers to obtaining these drugs, including required health insurance authorizations. Patients who needed the medications would sometimes be denied coverage or not receive the needed dose. Earlier this year, government officials dropped the authorization requirement. Now, any provider with an active Drug Enforcement Administration license can prescribe buprenorphine.
“With the dropped waiver requirement, more doctors are interested in prescribing these medications to patients,” Newby notes. “I’ve been doing more training for the medications and seeing more doctors show interest in this type of education.”
Care for Uninsured, Underinsured
The Myers Park Clinic Substance Use Treatment Program provides medical care and substance use treatment for uninsured and underinsured patients. They can also get medication for treating substance use disorders at a reduced cost. Program experts are seeing a smaller number of patients now – with plans for a full opening in May 2023.
The pharmacy at Atrium Health Carolinas Medical Center offers an injectable form of buprenorphine (administered by a provider) that lasts for 30 days. This is helpful for patients who have limited financing or limited access to local clinics that dispense the medication in pill form. This helps patients to manage their substance use cravings until they’re able to find an appropriate outpatient provider.
“People are much more interested in trying medications that reduce cravings for alcohol and opioids,” says Newby. “At Atrium Health Behavioral Health, we’re doing everything we can to make these treatments available to patients who need help managing cravings on their journey to sobriety.”
Treatment Centers and Community Programs
“Treatment of addictive disorders has dramatically improved over the last decade,” says Newby. “We recommend that patients take advantage of treatment centers and informal community programs to support their recovery.”
Treatment center programs include a psychiatrist for medication management, trained psychological counselors and group meetings for recovering patients as well as their family members. Treatment programs can be outpatient or inpatient, depending on the needs of the patient.
According to Newby, the 12-step community program for addiction in Charlotte, North Carolina, is very robust and provides a great environment to learn about addictive disorders and strategies for sobriety.
“There are meetings from 6 a.m. to midnight around the city,” she says. “And there are churches in every neighborhood, making meeting attendance very convenient. It’s easy to access the schedules and find meetings for specific age groups and backgrounds.”
For example, to access the schedule for local Alcoholics Anonymous meetings, visit charlotteaa.org.
Improved Quality of Life
Newby recognizes that most patients know that substance use is damaging to the body. But achieving sobriety is not easy.
“It requires a lot of strength, courage and effort to get sober,” she relates. “It requires a behavioral response to overcome addictive thinking. For example, you can replace substance use with healthy activities, like going to the gym or cooking a healthy meal.”
Newby has seen the amazing results experienced by her patients in recovery.
“Having a fully functional brain that’s not markedly disadvantaged by the ingestion of poisonous substances improves your quality of life dramatically,” she explains. “You’re able to process information, recall past experiences and make good decisions. When you achieve sobriety, your outlook on life becomes more positive, and you become more compassionate and engaged. It’s definitely worth fighting for.”
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• For more information about the Myers Park Clinic Substance Use Treatment Program, call 704-446-1252.
• For intensive outpatient services, call 704-446-0391 (Atrium Health Addiction Services - Ballantyne) or 704-344-3290 (Atrium Health Addiction Services - Charlotte).
• For inpatient detox services, call 704-304-5248 (Atrium Health Mercy). Assessments are available over the phone.
• For 24/7 mental health crisis assistance, call Atrium Health’s Behavioral Health Help Line at 704-444-2400.
Article updated on 3/28/23
