The COR Syndemic: The Overlap of COVID-19, Opioids, and Systemic Racism in Healthcare
Coronavirus has caused drastic changes to both private life and public health. According to researchers at the Rutgers Center for Alcohol and Substance Use Studies, however, the devastation from the coronavirus in the United States has been compounded by two more underlying public health crises: the opioid epidemic and systemic racism. Researchers and students (Hien, Bauer, Franklin, Lalwali & Pean) are proposing a new framework in which coronavirus, opioids, and racism are recognized as a concurrent COR “syndemic” (COVID-19, Opioids, and Racism. As the name implies, a syndemic is the convergence of multiple public health crises, and in the case of the COR syndemic, the flashpoint for all three seems to be traumatic stress. The results, Dr. Denise Hien argues, have been catastrophic.
”We really need to consider all three of these epidemics together in order to be most effective in developing strategies to address them over the course of time, as their combined mental health impacts will be felt for decades to come,” Dr.Hien said.
The researchers and students emphasize the importance of traumatic stress as a common underlying factor. COVID-19 has killed over 500,000 Americans in the past year alone, and public life still remains largely disrupted as a result. The individual and collective trauma from living through a year of mass death has, predictably, led to an increase in opioid usage. The Overdose Detection Mapping and Application Program (ODMAP) measured a 46% increase in overdoses after three months of stay-at-home orders, with a 71% increase in at-the-scene overdose deaths.
“We know that traumatic stress underpins opioid use and often predates the development of substance use disorders,” Dr.Hien said. “This means we have to address the trauma in order to make gains with helping people recover from their opioid use problems.”
The impact of race on the pandemic cannot be understated. A significant number of “essential workers” who could not shelter-in-place were black, indigenous, or people of color (BIPOC.) The combination of poor working conditions in warehouses, grocery stores, and delivery trucks combined with low-wages, few healthcare benefits, and almost no support from the federal government has led to an explosion of COVID-19 transmissions in settings where BIPOC workers are at an increased risk of exposure. Like the opioid crisis, the faces of frontline workers have been white-washed; white medical workers are the “frontlines heroes” while working-class, non-white people have become ill with the virus or even died delivering food, stocking shelves, and keeping the country’s infrastructure moving in the face of economic collapse. Furthermore, ongoing disparities in proper diagnoses and treatment of BIPOC patients remains one of the most glaring failures of the US healthcare system.
The overlapping effects of coronavirus, the opioid crisis has created a synergistic effect that will be difficult for researchers to untangle. The high death count in the United States has been driven by a lack of clear and coherent policy from the federal government, local leaders, and “over-resourced” communities that insist on seeing the pandemic as a non-racialized crisis. However, the data tells a very different story.
“The challenges of systematic racism call upon all of us to find ways to shed light on how structural barriers in our ‘spaces’ impede delivery of equitable care,” Dr.Hien said. “In the addiction field, this means connecting the dots between these epidemics—a syndemic framework helps us to move forward here, even if only one small step at a time.”
Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Center of Alcohol & Substance Use Studies