Before the COVID-19 pandemic was the drug epidemic. Its relentless toll added a record 90,722 overdose deaths in the U.S. for the year through November 2020, a grim number obscured by coronavirus casualties that recently topped 600,000, according to federal data released Wednesday.
As the virus transfixed the nation, the drug crisis spread to largely untouched parts of the country — exacerbated by the recession and millions of job losses. Not only stores and restaurants shuttered: Counseling services moved online, inpatient clinics closed and mobile clinics pulled back. Without support, many Americans relapsed and some turned to drugs for the first time.
Before the pandemic, U.S. unemployment hit a half-century low of 3.5%; today, the country is still missing almost 8 million people on payrolls. President Joe Biden’s administration is seeking full employment, but that goal will be daunting as businesses confront a workforce more addicted than ever.
Ronald Armstrong, a 57-year-old recovered heroin user and peer counselor, is noticing new faces when dropping off clean needles around Washington. Along Good Hope Road and in downtown encampments are people who are younger, and many who’ve never bought drugs before.
“When COVID happened, it compounded the situation, and made it more comfortable to say, ‘It’s OK now,’” said Armstrong. “‘Because I ain’t gotta work, ain’t nobody hiring anyway.’ That false reality of, ‘As soon as they open the city up, I’m going to get me a job.’ It’s not going to happen like that.”
Opioids are behind about three-fourths of the overdoses, according to Wednesday’s data from the U.S. Centers for Disease Control and Prevention. Washington was among the deadliest regions, seeing a 50% surge in deaths. Some of the impact is visible, such as the growing clusters of tents downtown where many overdoses occur, a sight so common that Federal Reserve Chair Jerome Powell mentioned them several times this year.
Much of the devastation in the capital and far beyond, though, is seen only by people on the ground like Armstrong, and offers an early warning of cracks in the broader economy.
About six hours southwest of Washington is Bristol, a city of roughly 50,000 people that straddles the border between Tennessee and Virginia. Once benefiting from agriculture, mining and steel, the birthplace of country music now depends on mountain tourism.
Businesses here have grappled with the opioid epidemic for years and the issue is once again rearing its head. At some white-collar companies, only four out of 10 applicants can pass a drug test, with many showing recent opioid use. Other firms have eliminated the tests altogether to get people in the door, said Beth Rhinehart, head of the region’s Chamber of Commerce.
“We hear all the time from folks that you have people who are capable and apply, and when they get to the drug-screen portion, they don’t pass,” said Rhinehart. “It certainly does kick a lot of people out of a lot of jobs. Our businesses need warm bodies right now.”
America’s drug use is closely linked to the economy. The opioid crisis cost the U.S. more than $2.5 trillion from 2015 to 2018, according to the White House Council of Economic Advisers. It’s one reason behind men’s sliding participation in the labor market.
Biden proposed more than $10 billion to combat the opioid epidemic in his fiscal 2022 budget, including funds for medical treatment and recovery programs.
In Maryland, 63-year-old Mark Robinson distributes needles and lifesaving Narcan, a nasal spray that can reverse an overdose. He knew the crisis was worsening when he was called to a drug house in a gated community last summer.
“Just like we weren’t prepared for the pandemic on the front end, we seem to be ill-prepared on the back-end for the exodus of people who have been experiencing undiagnosed things while shut in,” said Robinson, a program coordinator for nonprofit Family and Medical Counseling Service Inc. “This portal has been opened now, and I don’t think we’ll ever go back to what it was.”
Jasmine Torres, 28, thought she had beaten her own addiction to prescription opioids. Clean for almost four years, she worked as a pharmacy technician throughout the worst of New York’s COVID outbreak, never stopping even as colleagues and clients got sick. In the fall, she left for Oklahoma Baptist University’s nursing school.
But a few months later, she was quarantined for weeks largely on her own, with little to do but dwell on the pain she witnessed, the refrigerated trailers filled with bodies that she passed daily on the way to her job. Almost to the day of her anniversary of being sober, she broke down and called friends who had connections. She relapsed with Percocet in October.
“It all hit me at once. I bottomed out,” Torres said. She said she hasn’t used in six months, and came home after the first semester ended in November to a Bronx apartment she shares with her mother and grandmother. She now works in urgent care 40 hours a week for $17 an hour, saving for tuition to go back to school.
“I’m just glad New York isn’t how it was when I left,” Torres said. “It would’ve been extremely hard, if not next to impossible” to stay clean.
Another reason behind the increase in opioid deaths is the prevalence of fentanyl, a synthetic opioid that can be 100 times more potent than morphine. More than 80% of opioid deaths in the 12 months through November 2020 stemmed from such drugs. Many have no idea they’re taking them.
“We’ve had multiple people overdose at college parties that thought they had cocaine. We’ve had multiple people found deceased in hotel rooms that thought they had cocaine. We’ve had other people who thought they were taking Xanax and things and it turned out they were just taking fentanyl,” said Jack Weiss, deputy chief of the Charleston Police Department in South Carolina.
Fentanyl killed Anne Emerson’s fiance in 2017. Emerson, a recovering addict from Coon Rapids, Minnesota, now works with the Recovery Advocacy Project counseling four people addicted to opioids — three relapsed in 2020 and one ended up in prison. Last year, her one-on-one meetings moved onto Zoom, but her clients wouldn’t always show up.
“They’re going backward,” said Emerson, 42. Recovery was difficult during the pandemic because “there are no jobs, every business is being closed down, your meetings get shut down, and so do your resources for help.”
Down south in Louisiana, for every two people who died of COVID-19 in Orleans Parish last year, a hot spot for the virus, one died of an overdose. Now that the city has a better handle on the coronavirus, officials are redoubling efforts on opioids, stepping up education and outreach and buying hundreds of additional doses of Narcan.
“It’s here, and we’ve got to mitigate it before it becomes our next pandemic,” said Jennifer Avegno, director of the New Orleans Health Department. “Just like with COVID, health and economics are inextricably tied.”