KNOW NOW:
America's Unwell
Mental Distress Meets Deadly Opioids
This is mid-afternoon Baltimore, but it could be Anywhere, USA. The scene is so familiar, so disturbing, public eyes adjust to avert it. This is opioid overdose, and with 100 million-plus users in the United States, it happens every hour of every day. 2020’s toxicity -- the pandemic, the polarizing politics, the racism, the financial hardship -- pushed people beyond their pain limits, sending overdose rates to record highs.
Well before these combined crises, narcotics deaths escalated fastest among the urban poor, especially Blacks, Latinos, and Indigenous, those profoundly struck by COVID and hate mongering. Twelve months-plus of unabated death, fear, and isolation now leave the stable teetering and the vulnerable frantic. Addiction spikes dangerously among mentally ill, a fast-growing portion of the entire population that cuts across ethnicity, gender, and age.
Pre-pandemic data logged a fifth of all adults suffering anxiety and/or depression to full blown psychotic disorders; that’s 51.5 million Americans in mental anguish. Double that number for 2020: mental health professionals anecdotally report two times the pressure on their workloads during the past year. Those numbers reflect only those seeking help. Most do not. To low and no-income minorities in mental distress, psychiatrists, psychologists, and therapists are out of physical and financial reach, while hospital emergency rooms are ill-equipped to respond.
America’s poor who are involuntarily admitted to public mental health facilities find substandard care in a criminalized setting. There is no doctor with a longer term treatment plan, no wellness strategy upon discharge. It’s simply short term triage for people deeply disturbed.
By the end of 2019, 10 million mentally ill Americans, desperate for relief from mental and physical anguish, reached for something, anything. They found synthetic opioids, and quickly became addicts.
Savvy opioid producers have created US consumers since their 1990s campaign supplying doctors with a fast way to treat pain in white suburban and rural America. Big Pharma well understood the risks of patient dependence, showering the medical community with incentives to prescribe the narcotics, despite, if not because of the likelihood of addiction. Federal courts found that industry’s recklessness was matched only by its greed.
Opioid dealers also swept underserved urban markets with heroin, an early 1900s legal wonder drug that returned illegally, courtesy of organized crime. Soon its street appeal gave way to competing synthetic substitutes, more powerful, less costly, and often used to lace other illegal drugs. Enter Fentanyl, with 10,000 times greater potency than morphine. It’s now a common lure to youth in mental distress.
Brace for the fallout, caution clinicians and researchers looking at the past year's staggering data. ER visits for mental health episodes, suicide attempts, opioid (and other) overdoses, domestic sexual violence, child abuse, neglect, the list goes on. Why? Those gaping holes in mental and physical healthcare that Americans fall right through, dumping them into poverty, hunger, and homelessness. As their mental health needs increase, cheap opioids are the easy reach. The last time the Center for Disease Control clocked the crisis in the US, opioids killed five people every hour. That was 2018, well before 2020’s surge in overdose fatalities across almost every state.
Data from 61 million Americans clearly show that addiction and mental health distress lead to bad outcomes in the pandemic, a trend Nora Volkowo, Director of the NIH’s National Institute on Drug Abuse, examines. Grassroots groups trying to beat back social stigmas and connect the sick to services, are thwarted by exploding casework and lacking resources. Half of all Americans with mental health diagnoses also suffer from substance abuse, says Shatterproof's chief of public policy, Kevin Roy. To stop the increase, he and others argue, the vulnerable must become actual patients with integrated physical and mental healthcare.
The double diagnoses strike hardest at teens/twentysomethings: they’re the fastest growing demographic in mental health distress and the most likely addicts. They also account for the country’s deadliest dependence. Look at Maryland, where youth and young adult usage has pushed the state's opioid overdoses to third worst in the nation. Much of that happens right here in Baltimore, where widespread fentanyl and other synthetic opioid deaths even eclipsed the robust homicide rate. Five years ago, the city’s health department was so alarmed by fatalities, it tried to stock every household with the overdose reversing drug, Naloxone. But addictions and overdoses more than doubled, and today Baltimore has the highest drug fatality rate of all American cities.
Just outside downtown's imposing Central Booking and Intake, there’s usually a white mental health van parked curbside, ready to greet the newly-released. The majority of the corrections population suffer from mental disorders and addiction; untreated, the detainees are guaranteed recidivists. The local Behavioral Health Leadership Institute sends the van to meet those most difficult to reach, and hopes to attract them just as they walk out the front door. “Living in poverty, they suffer from trauma and depression and related disorders, not necessarily long term,” says Executive Director Deborah Agus, who’s anxious to begin working inside the jail, so inmates can learn about strategies and support before they hit the streets.
Residents in every US county desperately need counseling, therapies, medications, supportive housing. This time last year, the National Institute of Mental Health sternly, pointedly warned the medical community about opioid users with combined afflictions of pain and mental illness, contending that 30 percent of the drug-induced deaths called “overdoses” are actually suicides.
Here in Baltimore, and across a nation fractured, frightened and embittered, the leading cause of suicide is mental illness coupled with ready access to painkillers strong enough to sedate an elephant. Six months ago, nearly half of Americans reported a bout with depression or a suicidal thought. Our municipalities, states and federal government don’t require elaborate environmental scans or studies to show the urgency for nothing short of a Mental Health Corps, cultivated, deployed, and fast.
DO NOW:
There are boundless ways to learn more and engage. On evidence-based drugs, see why the National Academies of Science, Engineering and Medicine says we’re squandering help. With the anatomy of a minority in crisis, explore prevention and treatment programs tailored to communities. If you’re a civic leader searching for resources, a family member seeking help, or someone wishing to volunteer, SAFE Project offers abundant options. Considering school or credentials in the field? Earn a two-year mental health associate degree at your local community college, and plug your new skills into an array of opportunities. And if you need local help or you’re trying to assist someone from afar, finding treatment centers is easier by entering zip codes. More locators: Behavioral Health Treatment, Buprenorphine Treatment Practitioner, Single State Agencies for Substance Abuse Services, State Opioid Treatment Authorities. For help now, call the Substance Abuse and Mental Health Services Administration helpline. Free, confidential, bilingual: 1-800-662-4357.
Amy Kaslow
K/NOW Senior Researcher and Assistant Editor: Jordan Lee
Assistant Researcher: Elizabeth Marcinkowski