A naloxone box, containing the drug that helps reverse opioid overdoses and save lives, is set up outside the offices of Overdose Lifeline in Indianapolis. Indiana invested $4 million dollars since 2020 to make naloxone more available to the general public, part of its efforts to mitigate the opioid epidemic during the COVID-19 pandemic.
FILE PHOTO
The choice seemed impossible.
John Cunningham fought hard for his sobriety. Trapped by addictions to heroin, opioids and other substances, the Edinburgh native was certain he was headed for an early death. But after serving a short sentence in prison, he turned his life around, finding strength in his recovery through connecting with others in similar situations.
But when the coronavirus pandemic forced his entire world to stop and isolate in early 2020, Cunningham saw his network of support crumbling.
“I had a decision to make — do I focus on the epidemic or do I focus on the pandemic? For me, I did my best to not change as much as possible,” he said. “Early on, I knew money and Zoom meetings was going to lead to a lot of overdoses. And they did. So I made the choice to keep focusing on the epidemic.”
Cunningham maintained his recovery. The community that he had formed in 2018, Recover Out Loud, played an integral part in that.
But for thousands of others who were going through recovery for substance use disorders, the pandemic dealt a crippling and too often deadly blow. After years of incremental progress in stemming overdose deaths and drug arrests related to the opioid epidemic, those gains were whisked away over the past two years.
“A lot of the recommendations for the pandemic, they would have meant death for those in the epidemic,” said Meagan Cunningham, a Columbus resident. “When you take away resources that had been tools in your recovery, you had to get really creative. It came down to that choice — what can I do to find another tool that can work for me so I don’t return to where I had been?”
‘It’s scary’
The statistics rattled state officials.
The number of overdose deaths, emergency room visits and the use of naloxone, a drug that can reverse an overdose, all climbed in 2020 and 2021, and the Indiana Department of Health found a correlation between COVID-19 cases and overdose deaths.
Health officials have tried to take steps to stem the rise of deaths, including making naloxone more readily available and improving ways to find treatment. But much work remains.
“As we’ve worked through the pandemic, we’ve seen an evolution. Heading into it, we were on the right track. Our numbers were trending in the right direction,” said Doug Huntsinger, executive director for drug prevention, treatment and enforcement for the state. “But early on in the pandemic, we realized we needed to make sure we were increasing our harm reduction strategies.”
Indiana saw a 51% increase in overdose deaths between 2019 and 2020. In 2020, and the first 10 months of 2021, 2,882 Hoosier died from opioid overdoses. Between September 2020 and September 2021, overdose deaths rose 23%.
In Johnson County, overdose deaths also increased over the past two years. The county reported 19 overdose deaths from opioids in 2019, according to the Indiana Department of Health. Throughout 2020, 57 people died from overdoses in the county, and 21 overdose deaths were reported in the first 10 months of 2021.
Hospital and emergency room visits due to opioid overdoses have also risen. In 2019, the county reported 117 emergency room visits due to opioids, then 173 such visits in 2020. Through Oct. 18, 2021, 99 people had been admitted for opioid overdoses, with each month of the year showing an increase in visits compared to 2020.
A variety of factors plays into the increases.
One of the most concerning for state officials has been the spread of fentanyl, a synthetic opioid that can be 100 times more powerful than morphine. The drug is not only consumed on its own, but has been found mixed in everything from heroin to pills to cocaine.
Often times, people may not know they’ve taken the immensely powerful substance, Huntsinger said.
“In my opinion, this is the most dangerous time in our country to be in active use,” he said. “It’s scary.”
Changing routines
Throughout the pandemic, people in recovery faced a perilous mix of factors that threatened their sobriety.
Those in recovery relapsed due to stress and anxiety. Stimulus payments and unemployment benefits provided people with extra money to spend. Shuttered workplaces interrupted important routines.
Meagan Cunningham has been in recovery for three years. Not only did she use substances, but she had seen the people around her devastated by substance use disorder. Her father died of an overdose, and her mother was absent from much of her life due to addiction. Substance use disorder sabotaged a number of relationships she had been in. Those traumas left her broken and in need of healing.
Recover Out Loud helped her do that. As the pandemic set it, she felt it was important to maintain her support network, and though they took precautions, she continued to meet with others in recovery.
“We weren’t in large groups, but we were keeping our community that was already close together. We were making sure that they were being taken care of,” Meagan Cunningham said.
As a single parent, she also felt the crushing pressure of overseeing virtual learning with her children. She formed a separate group with others to keep encouraging each other.
“It got really rough for single parents. Most of us in the recovery community don’t have that family support. They don’t have anything to help them raise their kids. They rely on school and daycare,” she said. “It got really difficult for some mothers in our group. We lost some of them to relapse during that time, who had been sober for years.”
John Cunningham just celebrated 10 years of sobriety. Back in 2012, when he first entered recovery, he never imagined he would make it this far.
His struggles with substance use disorder stemmed from his teenage years. He was a 15-year-old Edinburgh teen teen when his father died of a heart attack. Witnessing his death severely impacted him, and he started using drugs. What started with alcohol and marijuana turned to opioids, such as hydrocodone, morphine and OxyContin, and eventually heroin.
Arrested twice for burglary, he served seven years in prison, where he got sober. He was released in 2014, and realizing how fortunate he was, he dedicated himself to giving back to others dealing with substance use disorder. Recover Out Loud grew from that desire.
Cunningham understood how important the support system was. He was determined to not let that diminish over the pandemic. He had people gather together, at a distance, in his backyard. Fitness classes were held on his porch.
“We kept our network up and running the best we could,” he said. “We did offer some Zoom meetings at first, but it just didn’t feel the same.”
Brittany Dyer found a sense of community that she’d developed vital to maintaining her sobriety.
She had struggled with a meth addiction from her teenage years until her early 20s, and though she had broken free from that drug, she still smoked and used alcohol.
As the pandemic settled in, the Columbus resident took advantage of Facebook Live to do workouts from home, including leading exercise routines for others.
“When the pandemic hit, I knew that I wanted to stay sober, stay in my roots and help other people,” she said.
A path forward
For state health officials, the initial focus when the pandemic struck was on harm reduction.
Since May of 2020, the state has invested $4 million in naloxone distribution. They helped fund the installation of 100 naloxone boxes, where people could get the life-saving drug 24 hours a day, at community agencies around the state.
Naloxone vending machines, which dispensed free kits containing a dose of naloxone, instructions on how to use it and resources for getting help, were unveiled in December.
“Our initial thought was, what can we do to make sure people are staying alive until we can get them into treatment,” Huntsinger said.
Moving forward, Indiana officials have continued to focus on getting naloxone to people who need it, and expanding access to care to treat substance use disorder.
The hope is to make it easier for residents to find and get treatment, he said. The state Division of Mental Health and Addiction completed an assessment of intake at treatment facilities, evaluating what that requires and the difficulties that people face, to make that process easier. They are also looking at providing a treatment locator, where people can compare different facilities and get a more clear picture of the treatments provided.
“It also does an assessment to help understand what treatment options they should be looking at,” Huntsinger said.
The past two years have been unimaginably difficult, John Cunningham said. But for those who remain in recovery, or who have come back after relapse during the pandemic, are encouraged as they move forward.
“Those of us who stuck through it, our bond is stronger now,” he said.
