Published March 29th, 2021 at 2:34 PM
It began with a pill.
Chronic pain compounded by age-old injuries — a cracked skull patched with a metal plate, a rib fracture and numerous nose breaks — hurt so much that Mari D. could hardly eat.
So she reached for the hydrocodone. It was the only thing that made her feel better.
She was also depressed. A few months earlier, she was energized and unstoppable, which is also known as a manic episode of her bipolar disorder diagnosis. Then the depressive episode hit, only worsened by her father’s death.
Soon, she began taking the pills like Tic Tacs.
She had been rushed to the emergency room multiple times for severe seizures brought on by an overdose. Those happened every other month. That was 2018.
Fast-forward to May 2020. Stuck in a years-long depression, she decided to stop taking her medication for bipolar and picked up a needle instead of a pill.
Mari D., who shared her story anonymously to protect her personal health privacy, is one of the many people who’ve relapsed in the pandemic and survived. Others with opioid use disorder did not.
This may be why a reader asked curiousKC: “While COVID-19 and protests for change are front and center has anybody remembered the opioid crisis?”
The opioid crisis was already bad, but data showed a sharp rise in drug-related overdose deaths when the coronavirus prompted global shutdowns.
The Centers for Disease Control and Prevention (CDC) reported there were 81,000 overdose deaths between May 2019 and May 2020, the highest number of opioid overdoses and deaths in a 12-month-period. Deaths were also on the rise in Kansas and Missouri, according to an AP News report from August 2019.
Synthetic opioids were identified as the “primary driver” of the increases.
“It’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences (of the COVID-19 pandemic),” said Dr. Robert Redfield, former CDC director, in December.
Experts say this crisis within a crisis has shone a light on the cracks in the mental health system and recovery programs.
Dr. Paul Christo, professor in the pain division at Johns Hopkins University, said it’s been difficult.
“Chronic pain affects, gosh, over 100 million people in the United States alone and worldwide it’s 1.5 billion people. So we’re talking about a lot of people who suffer from chronic pain, you know,” Christo said. “This is pain that doesn’t go away that affects lives adversely and leads to a lot of disability during the pandemic. I think what we’ve seen is, unfortunately, a lack of access to pain specialists and to pain treatments.”
So, folks reach for the next most accessible drug, which at times has been laced with methamphetamines or another dangerous cocktail. This has led to unintended overdoses.
Dr. Christo said several things can help: access to medicated-assisted treatments; free access to the opioid reversing drug Narcan, also known as Naloxone; and mental health support.
“Support groups are so important in terms of getting healthy and maintaining sobriety,” he added.
Another hurdle is that people seeking recovery struggle to find help when they need it.
NPR reported that many times it’s difficult for friends or family members to decipher legitimate recovery or rehabilitation programs from predatory for-profit programs. NPR reported that some for-profit recovery programs have been exploiting people for their insurance rather than treating them for their disorder.
Another issue is the focus on rehabilitation without first identifying trigger points, said Grace Yasmine, who’s been a nurse for 15 years and is also a trauma recovery coach. Yasmine also understands the mental health impact of mental illness and addiction. Her mom had bipolar.
Yasmine said an often invisible symptom of addiction is trauma. She saw this with veterans during her time as a nurse.
“When you have had trauma, there’s always this underlying fear of, ‘The worst is going to happen’,” she explained. “That constant reel of anxiety, sometimes that alone will send people towards addiction because (they) just want to … be calm.”
It took asking them questions about how or what they were feeling for them to verbalize their traumatic experiences. They simply wanted to feel numb.
Yasmine is a big proponent of talking people through their anxieties. She said talking is an important way to help folks with deep-seated traumas, so they’re able to navigate what they’re feeling in the moment.
She believes folks with trauma live with two different personas: “the person that we are today and the hurt scared person that we were in the trauma.”
“Nobody teaches us that process. And that’s why the addiction cycle continues,” she said.
Untreated mental illness is another, which is prevalent in communities of color. Studies show that delays in treatment lead to crises, which many times lead to suicide or addiction.
“With the, um, Latino community and the African American community, those are both communities where … (it’s) been ingrained in our culture that you can get through anything on your own,” Yasmine said.
Angela Manns, vice president of Wells and Recovery Services at ReDiscover Behavioral Health, a nonprofit behavioral health and substance use disorder service in Kansas City, can attest to the pattern.
“A large part of the population that has substance abuse disorders has a history of trauma and abuse,” she said. “When you have PTSD and flashbacks and relive those instances that you’ve been through, you want to get to a place where you don’t feel anything. … That’s where the substances come in. If you don’t feel it then you’re better.”
Manns has been a nurse since 2009 and recently graduated as a psychiatric nurse practitioner. In her time at ReDiscover, she’s learned the value of combining the medicated assisted treatment Dr. Christo mentioned earlier and mental health treatment, such as group and individual counseling.
Medications such as suboxone, and methadone help curb cravings. Counseling helps the person process and navigate through the mental fog and confusion.
The problem is, Manns said, there’s great – and widening – need for accessible treatment for people with limited incomes or little knowledge of how to take the first step toward help.
That need existed before the COVID-19 pandemic and has only gotten more urgent. People who were in recovery were suddenly left without their support network, forced online or completely removed from group therapy.
“We’ve seen more people relapse since the pandemic started,” Manns said.
She attributes pandemic stressors, which some experts call communal trauma, as accelerators for folks with mental health disorders such as bipolar or depression compounded with substance abuse disorders. Tack on pandemic-related economic stresses such as homelessness and joblessness and it can snowball out of control.
These pressures have placed weight on the health care infrastructure that was already weak.
“We don’t have a mental health system in this country to sustain all the people (who) need it,” Manns said.
Access to therapy or counseling is already scarce. People are struggling to sign up.
“Even here in the Kansas City area some of the mental health providers are scheduled out until June already,” she said.
Part of the problem has to do with funding. Not only does money help build more clinics to serve the community, but it also helps clinics attract much-needed experts.
Smaller nonprofit clinics sometimes struggle to retain employees because they cannot compete with what private clinics can pay. However, community mental health centers were meant to serve as a resource for folks who didn’t have insurance or couldn’t afford mental health services.
Groups like MO Hope Project (MHP) based in St. Louis aim to bridge that gap. Missouri’s Department of Health and Senior Services partnered with MHP to provide more public resources and training.
In Kansas City, counseling centers like First Call offer support not only to folks seeking help with their substance use disorder, but also family or friends. That program is called “How to Cope.”
The road to recovery is personal for Ann Schlafer, who said she’s in continuous recovery. Her personal experiences of having a substance use disorder help her at her job as a crisis call counselor at First Call.
“There’s definitely still a stigma towards, um, people with substance use,” Schlafer said. “I think there’s definitely an idea that it’s a moral issue … or that it can just be something that you can just choose to stop on your own, which is generally not the case.”
During the past year with First Call, she said the volume of calls hasn’t necessarily increased but the intensity and length of calls have.
Calls typically lasted 10 to 15 minutes and now they’re closer to 45 minutes. People she talks to are worried most about immediate access to resources that can help curb their addiction.
“When they call and ask for help, they want to get help immediately,” she explained. “Unfortunately, with the pandemic, resources are at the max. So there are waiting lists and things of that nature.”
She explained that with the opioid crisis coinciding with the pandemic, folks want to feel relieved fast.
“They want to get away from, um, the feelings essentially,” she said.
Many times when callers are routed to Schlafer, she isn’t their first stop. They have likely been talking to various clinics in town and have been scared away by the high price tag that some rehabilitation facilities quote. She said in-patient programs can cost someone around $30,000, which is needed for folks who are abusing drugs such as opioids.
Her goal as a counselor is to counter discouragement from seeking help. Barriers to help are frustrating, she said, but she’s there to hear people out.
“It’s not me telling them, ‘Well, you need to go to this type of treatment or you need to do this or that.’ It’s asking them, ‘What do you want to do in this situation? What are you willing to do? What are you not willing to do?’ ” she said.
“I’ve found that it is not helpful (saying), ‘You have to do this.’ That never worked with me for sure.”
At this point, the onus is on the person to want to get help. However, the systems in place require extra support. Above all, people cite the need for compassion.
“If you’re able to, if nothing else, have compassion for those people,” Yasmine said. “We all want to feel seen. And what I’ve found in many people with (addiction) is that they haven’t felt seen for a really long time.”
If you or a loved one need a place to start, here is a list of centers in the Kansas City area recommended by local social workers, case managers and mental health experts.
+ First Call, a crisis counseling center that offers counseling through their hotline 816-361-5900 and programs for people with substance use disorders and family members. Open 24/7.
+ Heartland Center for Behavioral Change provides behavioral health care and substance use disorder services. Click here or call 816-421-6670.
+ ReDiscover Behavioral Health, a mental health center, provides comprehensive programs and services to anyone, including the family members of those, with a substance use disorder and/or mental illness. Click here for a list of services. Call their opioid treatment clinics 816-965-1151 or their help line 844-99.4HEAL
+ Truman Medical Center’s Behavioral Health programs, which provide medical detox services, counseling, relapse prevention and education. Click here to view a full list or to get in contact. Call to make an appointment 816-404-5850 or call the crisis hotline 888-279-8188
+ Substance Abuse and Mental Health Services national helpline, open 24/7 — 1-800-662-HELP (4357)
Vicky Diaz-Camacho covers community affairs for Kansas City PBS.