Writing headlines in America has become a practice of writing obituaries for the masses. Over the past couple of months alone, the headlines remind us of the scale of devastation that is happening around us—100,000 dead from drug-related overdose during the first year of the pandemic, 840,000 dead from the virus, more than 100 feared dead when tornadoes struck parts of Kentucky and Illinois.
The toll of these events compound on each other; we are living through multiple mass casualty events and carrying the heaviness of grief. Though seemingly independent, these events are in fact connected to each other. While drug overdose deaths were rising steadily for years, it was the pandemic that caused deaths to skyrocket to current levels. Experts fear we are entering an age in pandemics in part due to destruction of habitats and loss of biodiversity, promoting the emergence of new pathogens. But even before the pandemic, climate change was having an impact on drug use and overdose deaths.
For years now, the United States has been undergoing a massive drug overdose crisis. While the roots of this crisis lie in the overprescribing of pain medication, nowadays most people are overdosing on illicit drugs obtained on the street. Most of these overdoses are attributed to opioids, specifically the potent opioid, fentanyl—which can cause an overdose more easily than other opioids. Fentanyl is now found in all sorts of drugs and overdoses involving more than one substance (like cocaine and fentanyl, meth and fentanyl, and benzodiazepines and fentanyl) are increasing. In essence, no one knows exactly what they are getting in today’s drug supply and it can vary from region to region.
Natural disasters are disruptive events, whether it’s a hurricane, snowstorm or tornado—homes are destroyed, services are interrupted, and lives are uprooted. Routines are changed as people have to adjust to new living environments and navigate where they can find essential services. It can be a stressful time and drug use is one way people cope with stressful situations. One study looked at survivors of Hurricane Sandy and assessed whether or not they were at high risk for opioid use disorder and compared it to how exposed they were to the hurricane. Hurricane exposures could be in knowing someone who lost their life or was injured or could be related to losing property or money. What they found was that the higher one’s hurricane exposure, the higher one’s risk for opioid use disorder.
Natural disasters are disruptive events…and drug use is one way people cope with stressful situations.
Of course, not everyone who uses drugs is at risk of a substance use disorder—people can use drugs without getting addicted. However, these sorts of disruptions can pose other issues; namely, not being able to access the drugs you are used to using. Researchers in New York City interviewed people who inject drugs in the aftermath of Hurricane Sandy in 2012; 60% reported going through withdrawal because they couldn’t access their usual drugs and 27% of people either shared needles and drug equipment or used drugs with people they didn’t know. Sharing needles and equipment can lead to an increase in infectious disease like HIV and withdrawal sickness can lead to an increased risk in overdosing.
If you don’t have access to your regular supply of drugs, you might try to use a supply you’re not familiar with and with the drug supply across the United States mixed with the powerful opioid fentanyl and other adulterants, you may be taking a stronger dose than you’re used to—leading to an overdose. You may not be around people who know what to do when someone overdoses or carries naloxone—a drug that reverses the effects of opioids—or you may not be around anyone at all. With fentanyl being found in all sorts of drugs, this is a concern for both casual and regular users.
For those who are receiving medications like methadone to treat opioid use disorder, disruption can have huge impacts. These drugs are weaker opioids that need to be taken daily to avoid withdrawal symptoms and for many people, it involves a daily lineup outside of a special clinic that will give them the dose. Earlier this year, when Texas experienced its worst winter storm in nearly a century—addiction medicine doctors reported that people could not easily get their methadone because the storm had forced clinics to close. Emergency departments of hospitals served as backup sites for people to get methadone, but people had trouble getting there due to the storm. Emergency departments were also overwhelmed with other issues and some were reluctant to prescribe methadone. In the end, some people did experience withdrawal symptoms as a result. Similar barriers were reported by health providers in New York City in the aftermath of Hurricane Sandy and by providers who were dealing with new patients who had been evacuated from New Orleans in the aftermath of Katrina.
Providers who prescribe drugs like methadone and buprenorphine (another drug that prevents withdrawal) are often subject to cumbersome regulations which makes it difficult on a regular day to get people their medication, not to mention during a climate-induced emergency. Some of these regulations, like requiring people to show up in person to get methadone rather than be prescribed take-home doses, have been temporarily rolled back due to the pandemic but not all providers are taking that step.
Our vision for ending the drug war looks like creating a world where people have housing, healthcare, and have their needs taken care of.
The effects of climate change on drug use isn’t just limited to disruption caused by spectacular events like hurricanes or winter storms—changes in temperature can also cause issues. Researchers at Brown University examined overdose death data from Rhode Island and Connecticut and looked at the temperatures in the days preceding the death. What they found was that lower average temperatures in the three to seven days before the death were associated with higher rates of overdose death. Opioids reduce the body’s temperature and, consequently, affect the temperature at which the body shivers. This is a particularly urgent concern if you’re living on the street or living in housing that has no heat.
Harm reductionists, who work with people who use drugs and some of whom use drugs themselves, do not seek a future in which drugs do not exist. Like alcohol, people will always use drugs. Instead, we seek a future in which overdoses and drug-related harms are limited, if not eliminated. The immediate steps to this look like opening safe consumption sites where people can use drugs safely under supervision—intervening in case of an overdose. It looks like pushing for a safe, regulated supply of drugs people can access so that they don’t have to rely on street drugs. It looks like opening more syringe service programs, expanding access to methadone and buprenorphine, and pushing for decriminalization, regulation and legalization of substances. We realize that like alcohol, even under a regulated environment, some people may still be harmed by addiction—this is why our vision for ending the drug war looks like creating a world where people have housing, healthcare, and have their needs taken care of; creating a system of support.
These overall goals are the same as that of the climate justice movement and they demand the same type of expansive imagination. They are often met with the same type of derision from status quo politicians. But while they may demand that we consign ourselves to a future of mass death, we don’t have to accept that vision as our own. Our imaginations can be bigger.