The covid-19 pandemic is one of the most challenging circumstances ever encountered in the history of the United States. The isolating shelter-in-place orders that are in effect in all but 9 states presents a unique set of difficulties for both the prevention and recovery communities.  The disease of addiction is characterized by profound feelings of isolation. By the time users have spiraled deep into the disease, they have long since cut themselves off from support systems such as work, friends, and family. Thus, for many in recovery, isolation can be a powerful trigger to relapse, especially forced isolation. In fact, one of the first signs that a person in recovery is headed toward relapse is that they start isolating themselves consciously or unconsciously. The forced isolation of shelter-in-place, coupled with the resultant feelings of depression, anxiety, and boredom represent great threats to the sobriety of large numbers of Americans. Furthermore, many have already lost jobs and face an uncertain economic landscape. Research has shown that suicide and overdose, so-called deaths of despair, increase during times of economic downturn.

In light of the widespread isolation, uncertainty, and despair, the coronavirus stimulus checks, though essential for our economy, add an additional layer of complexity to the issue as many will be tempted to spend that money on substances in order to cope with the mounting pressures posed by the pandemic. This is especially worrying for those in recovery from opioid addiction as they are most likely to die from an overdose during a relapse due to diminished tolerance. You can be sure that synthetic opioids are still available in great abundance as darknet markets remain open for business. In fact, international and domestic mail is probably getting a lot less scrutiny these days than it usually does. Furthermore, fentanyl and its analogues are extremely potent on a per weight basis and thus easily smuggled, especially through mail. It follows then that North American dealers probably already have enough fentanyl stashed away to meet the nation’s demand many times over.

If we learned anything from the Rat Park study, it was that addiction flourishes in the absence of community and meaningful connection. For those not familiar with the study, a group of rats were intentionally isolated and addicted to heroin in the 1970’s. Once the addicted rats were returned to a community of non-addicted rats, replete with toys, puzzles and food (the Rat Park), they reintegrated themselves into the community by voluntarily undergoing withdrawal and eschewing further use of heroin (which was made available to them in the Rat Park). Let this be a call to action for those in the prevention community to develop novel strategies and resources to help vulnerable populations resist the temptation to seek relief in substances while those in the recovery community seek to reinforce existing support networks, virtual or otherwise.