This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Between April 2020 and April 2021, opioid-related drug overdoses killed more than 2,900 Michiganders — a 19% increase over the preceding year. A substantial number of opioid-related deaths occurred in May and June 2020, shortly after the COVID-19 pandemic began. Isolation, boredom, financial stress, loss of loved ones, and being in constant close quarters with housemates (in some cases abusive parents or spouses) are all believed to have increased substance use disorder (SUD) during the pandemic.
Dr. Debra Pinals.
"We were seeing some declines in 2018 and 2019, so that was a sign of hope. But the COVID pandemic has had an impact," says Dr. Debra Pinals, Michigan Department of Health and Human Services (MDHHS) medical director for behavioral health and forensic programs. "We don't know fully all the reasons for all this shift. There's been potentially more access and more synthetic opioids, such as fentanyl, which has really impacted the epidemic and made it more deadly. At the same time, a lot of treatment interventions have switched to virtual to reduce the risk of people getting COVID-19. So we've seen a lot of shifting sands."

Across Michigan, health professionals are racing to understand which communities have been hit hardest by SUDs during the pandemic – and how to turn the trend back around. 

Communities at risk

Black males in large and mid-sized urban areas, and white males in rural areas, experienced the largest increases in overdose mortality rates during May 2020. However, Pinals says more Black and Hispanic people have died from drug overdose compared to white populations overall.

"That's very discouraging in terms of disparities. While we're seeing increases across all ages, the biggest increase seems to be in the younger population, under 24," Pinals says. "The [Michigan] Opioids Task Force is ... looking at the reasons and how to reduce the racial disparities as a major issue and a major pillar of focus. The task force also identified several other areas  — criminal justice-involved individuals, maternal and infantl overdose rates, and children that are born with opioid use disorder."

Michigan's Indigenous residents are also experiencing rising overdose rates. The Intertribal Council of Michigan Tribal Perinatal Opioid Use Disorder program serves women and infants from three tribes in the Upper Peninsula: the Bay Mills Indian Community, the Sault Tribe of Chippewa Indians, and the Keweenaw Bay Indian Community. According to Connie Deplonty, the program's manager, Michigan's Indigenous populations struggle with poverty and joblessness. Many are located in remote rural areas, hours away from grocery stores, doctors' offices, and, often, cell phone and internet service. Many are crowded in inadequate housing and they lack transportation and even running water. All of these stressors can lead to unhealthy behaviors, including substance abuse.
Connie Deplonty.
"The reasons behind poverty and unemployment issues within the tribal communities stem from historical and systematic failures," Deplonty says. "The impact of substance abuse on tribal families continues to be an area of great concern. Drugs have taken loved ones from their families. Parents have lost children. Children have lost parents. It just seems to be a vicious cycle that is destined to repeat itself over and over again."

Through building trusting relationships and then offering home visits, the Tribal Perinatal Opioid Use Disorder program seeks to break that cycle by offering this extremely vulnerable population of Michigan moms and babies access to medical care and needed resources, including food and housing.

"We're trying to connect families with services and specialty care providers, such as [obstetricians], especially when moms might be delivering babies who are addicted," Deplonty says. "UP Health Services - Marquette is currently our only neonatal unit in the entire UP."

Harm reduction gives whole families hope

With offices in Traverse City and Petoskey, Harm Reduction Michigan helps Michiganders with substance use disorders stay alive until they are ready to overcome their addictions. Its services include training organizations and professionals as well as free harm reduction services at drop-in centers in Traverse City and Petoskey. Its director, Pam Lynch, sees the data on drug overdose in real time, in real lives — and the impact of lives lost on families and communities.

"People use substances as a coping skill," Lynch says. "The COVID epidemic has created more challenges for people. Many people have had more stressful situations and fewer resources to deal with them. In a number of situations with overdose deaths, from client reports, it was more the loss of jobs because of COVID that made people feel more hopeless. Then, other factors pile up. For some, if you lose your employment, not long after you're going to lose housing."
Pam Lynch.
In addition, Lynch says methamphetamine use has increased exponentially. She says many are calling methamphetamines the fourth wave of the opioid abuse epidemic. Many people who had opiate problems now have methamphetamine problems. Illegal suppliers are cutting a lot of meth — and cocaine — with fentanyl (a deadly synthetic opiate).

"People are dying of overdose when in fact they didn't even necessarily know they were ingesting fentanyl," Lynch says. "Our overdose deaths are going to continue to rise because, frankly, there isn't the political will to make some of these changes that need to be made."

Lynch believes state and local governments must make a substantial reversal in how SUD is handled by decriminalizing drug use, creating safe injection sites, and expanding other harm reduction strategies. New York State opened the first safe injection sites in 2021. The Justice Department has indicated it may approve safe injection sites and a National Institutes of Health call for harm reduction research mentions the sites among other approaches. Globally, about 100 safe injection sites are saving lives in locations including Europe, Canada, and Australia.

"We have to really consider how this disease has not been handled by conventional means," Lynch says. "We really have to consider some radical programming and I don't see that being considered in Michigan at this point."

Help available online

However, help is available for Michiganders struggling with SUD and those who care about them. The state of Michigan lists a number of opioid epidemic resources on its website. Individuals and organizations can request free Naloxone, an emergency treatment for opioid overdose, and training in administering it. The state's website also shares help lines, treatment options, resources for professionals, an overview of Michigan's drug laws, and current data on the opioid epidemic.

"We're also investing in getting treatment in emergency departments for people who show up with non-fatal overdoses, and harm reduction strategies like syringe service programs," Pinals says.

In addition, the site promotes the End the Stigma campaign, which encourages Michiganders to change the conversation about SUDs. The campaign asks Michiganders to reduce stigma and promote social inclusion by treating people affected by substance use disorder with respect. It encourages people to learn more about mental health conditions so they can correct others with misconceptions about SUDs and mental illnesses. Campaign literature states, "People with substance use disorders and people in recovery are more likely to seek substance abuse treatment and maintain sobriety when they develop social connections. Isolation, discrimination, and prejudice are obstacles to social inclusion."

The state is also working on expanding recovery housing, providing technical assistance to treatment providers, and training practitioners to treat SUD. In addition, the new Michigan Crisis and Access Line (MiCAL) provides phone, chat, and text support for Oakland County and U.P. residents experiencing mental health or substance abuse crises. A statewide, regional rollout is planned by fall of 2022.

"Overdose deaths remain a significant concern. Looking at the data helps us understand where we need to double down in our efforts," Pinals says. "Our efforts before the pandemic were helping to set a downward trend, so we're hopeful. We'll continue to work on what we think works and develop new strategies as we learn more about how the substance use trends are evolving."
 
A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Pam Lynch photos by John Russell. All other photos courtesy of the sources.