Persons experiencing addiction may be at very high risk of infectious disease like COVID-19 due to high rates of smoking, recent imprisonment, conditions like HIV/AIDS, and high-risk behaviors (Ezzati et al. 2002; Farhoudian, et al. 2020). During the COVID-19 pandemic, most courts have shuttered, and treatment center admissions have halted, yet the opioid crisis rages on. Addiction intersects with material hardship, trauma, broken institutions, and human frailty in a multidimensional web of disadvantage (Desmond and Western 2018)—a process illustrated by COVID-19.
In interviews I conducted in Michigan District Courts for Washtenaw County in 2018, local judges estimated that 4 of every 5 criminal defendants struggle with substance use disorder, implying addiction is an underlying cause or correlate of America’s burgeoning carceral state, a finding echoed in recent sociological scholarship (Harding et al. 2019; Western 2018). To be clear, 80 percent of criminal convictions may not entail drug or alcohol charges; rather, substance abuse may have prompted the underlying criminal act (e.g., robbery or domestic violence).
Recognizing the risk of COVID-19 in tightly packed jails, many governors have suggested releasing non-violent offenders, while some scholars argue for releasing violent offenders as well (Prescott et al. 2020). This is not a remote concern, as nearly 1 in 2 Americans have had a family member incarcerated (Kelley 2019).
Moreover, as COVID-19 has inundated hospitals, overdoses or withdrawal symptoms like seizures may receive reduced or no treatment, potentially increasing mortality rates for persons with substance use disorders. America’s opioid epidemic may have just become more lethal and socially costly.
Drug overdoses are now the leading cause of death for Americans under age 50 (CDC 2020; Drug Policy Alliance 2020; Katz 2017), costing the U.S. approximately $696 billion in 2018 (Lopez 2019). Even where substance use is not fatal, its economic costs (legal involvement, health care, and lost productivity) are significant (Katz 2017). COVID-19 presents a broader multidimensional policy challenge; it is anticipated to surpass overdose as a leading cause of American death in 2020 (WHO 2020), and produce unprecedented economic devastation.
While a singular solution to the opioid crisis is unlikely, law enforcement, government officials and sociologists generally concur that resources should focus on treatment programs (Katz 2018). Addiction treatment centers are an important forum for studying the intersection of COVID-19 and the opioid epidemic. My related field work suggests that access to housing and employment are key elements in supporting sustained opioid abstinence following initial detox and acute treatment(see Removing Barriers). Acute withdrawal from opioids lasts about five days, but long-term abstinence rests upon people having their basic needs met.
In my sample, clients undergoing treatment during the COVID-19 pandemic at Dawn Farm, an inpatient and outpatient comprehensive treatment center in Michigan, have fortunately retained housing. Upon admission, 33% of clients entering residential treatment, 52% entering detox, and 62% entering transitional housing were homeless. Currently, 100% of them have stable housing. Furthermore, those who completed their treatment module during the COVID-19 quarantine have been given the option to remain. However, residents may be discharged from treatment if they relapse. COVID-19 quarantine restrictions have, however, limited intake for new clients which reduced the number of people who the center can house.
Most clients enter treatment unemployed. Upon admission, 85% of clients entering residential treatment, 75% entering detox, and 56% entering transitional housing were unemployed. Of these treatment phases, only transitional housing (last in the treatment sequence) permits employment, and rules require all physically capable residents to find work upon move-in. At the start of COVID-19, only 4 of 107 (3.7%) transitional housing residents were unemployed. As of March 31, 2020, one week after Michigan Governor Gretchen Whitmer’s stay-at-home order, 51% of transitional housing residents had been laid off, raising the unemployment rate to 55.1%. Another 15% of clients had hours reduced by 50% or more, with yet another 7.5% experiencing their hours reduced by less than 50%. In total, 77.6% of residents are under-or-unemployed during the COVID-19 pandemic.
An already lethal crisis has become even more potent as the opioid crisis and COVID-19 pandemic coincide. In addition to a new public health agenda, housing and labor market policies must be enacted to avoid the homelessness and despair that exploit human frailty and pull people out of recovery from addiction.