As the world’s attention remains focused on the COVID-19 pandemic, essential attention is turned away from other life-threatening epidemics, including opioid addiction. Prior to the COVID-19 crisis, opioid misuse and addiction had become rampant in the U.S. In the late 1990s, drug companies assured doctors that opioid pain relievers were safe and nonaddictive, leading to an increase in prescribing rates.
Opioid overdose rates increased rapidly as it became clear that opioids can be highly addictive. In 2018, 46,802 Americans died from an opioid overdose while 1.7 million suffered from substance use disorders related to opioid pain relievers.
The economic burden of prescription opioid misuse alone is $78.5 billion in the U.S. annually, which includes not only health care costs but also lost productivity, addiction treatment and criminal justice involvement.1 The economic toll, and the death toll, from the opioid epidemic is, sadly, set to rise even further now that it has collided with the COVID-19 pandemic.
COVID-19 Pandemic Heightens Risks for Opioid Addicts
There are physical and psychological reasons why COVID-19 poses a significant challenge for people with opioid use disorder (OUD), which affects at least 2 million Americans, and those who misuse opioids — another 10 million.2 Worldwide, 40.5 million people struggle with opioid dependence, a global prevalence of 510 cases per 100,000 people.3
Chronic respiratory disease increases the risk for fatal overdose in people who use opioids, and COVID-19 leads to compromised lung function.
Further, opioid misuse can lead to slowed breathing and hypoxemia, which can cause cardiac, pulmonary and brain complications, as well as overdose and death. As such, according to an article in the Annals of Internal Medicine, “these individuals may be at increased risk for the most adverse consequences of COVID-19.”4
People who are addicted to opioids may also be more likely to suffer from conditions that make them more vulnerable to COVID-19, including being a smoker who suffers from lung or heart disease, being homeless or having experienced other health effects from drug addiction.5 Threat of infection aside, there are a number of indirect ways that people with OUD may be adversely affected by COVID-19 as well.
“Before the first COVID-19 case in the United States, a different epidemic — the opioid crisis — was taking the lives of 130 Americans per day,” wrote two doctors from Yale School of Medicine in Annals of Internal Medicine.
“Given that infection epidemics disproportionately affect socially marginalized persons with medical and psychiatric comorbid conditions — characteristics of those with opioid use disorder (OUD) — we are gravely concerned that COVID-19 will increase already catastrophic opioid overdose rates.”6 Some of the challenges faced by people with OUD during the COVID-19 pandemic include:7
Closure of substance use treatment clinics
Focus of emergency departments on COVID-19 patients — not opioid overdose
Social distancing and shelter-in-place orders adversely affecting mental health
Disruptions in Care, Increased Anxiety Are Problematic
Disruptions of care during the COVID-19 pandemic are a major concern for people with opioid use disorder, who depend on regular face-to-face health care. Many rehab facilities have closed, limited programs or limited new admissions over fears of COVID-19 spreading in a communal living facility.8
Access to medications for addiction treatment may be restricted, while patients may also face simultaneous challenges like loss of work, housing and food security, which could trigger a downward spiral leading to relapse and delayed recovery.
“The COVID-19 pandemic strikes at a moment when our national response to the opioid crisis was beginning to coalesce, with more persons gaining access to treatment and more patients receiving effective medications. COVID-19 threatens to dramatically overshadow and reverse this progress,” according to researchers with the Johns Hopkins School of Medicine.9
The social isolation imposed by the pandemic is also highly problematic and, by increasing stress and anxiety, could heighten substance abuse, opioid usage and overdose.
In addition to limiting access to peer-support groups and other vital sources of social connection for recovering addicts, “Persons who are isolated and stressed — as much of the population is during a pandemic — frequently turn to substances to alleviate their negative feelings,” wrote Dr. Nora Volkow with the National Institute on Drug Abuse. “Those in recovery will face stresses and heightened urges to use substances and will be at greatly increased risk for relapse.”10
There’s also the issue of social isolation indirectly contributing to overdose deaths because no one is there to administer naloxone, an overdose-reversing drug. Volkow continued:11
“Social distancing will increase the likelihood of opioid overdoses happening when there are no observers who can administer naloxone to reverse them and thus when they are more likely to result in fatalities.
Emergency department physicians with increased caseloads may be less likely to initiate buprenorphine therapy for patients with OUD, which is an important component of mitigating the effects of the opioid crisis.”
There are even reports of stigma and discrimination, according to Dr. Peter Grinspoon, who recovered from opioid addiction and teaches medicine at Harvard Medical School. “There are reports surfacing of police departments across the country that are refusing to offer naloxone to patients who have overdosed, on the pretext that it is too dangerous because the ‘addict’ might wake up coughing and sneezing coronavirus droplets.”12
Job Loss Associated With Opioid Overdose Deaths
The U.S. unemployment rate may skyrocket to 32.1% in the second quarter of 2020, according to the Federal Reserve Bank of St. Louis.13 Previously, the highest rate of unemployment in U.S. history was 24.9%, which occurred in 1933 during the Great Depression.14 The massive job losses may singlehandedly increase opioid overdose deaths, as a strong connection has been revealed between the two in the past.
A 2019 study in the Medical Care Research Review journal looked at the effects of state-level economic conditions — unemployment rates, median house prices, median household income, insurance coverage and average hours of weekly work — on drug overdose deaths between 1999 and 2014.15 According to the authors:
“Drug overdose deaths significantly declined with higher house prices … by nearly 0.17 deaths per 100,000 (~4%) with a $10,000 increase in median house price. House price effects were more pronounced and only significant among males, non-Hispanic Whites, and individuals younger 45 years.
Other economic indicators had insignificant effects. Our findings suggest that economic downturns that substantially reduce house prices such as the Great Recession can increase opioid-related deaths, suggesting that efforts to control access to such drugs should especially intensify during these periods.”
An earlier investigation, published in the International Journal of Drug Policy in 2017, also connected economic recessions and unemployment with rises in illegal drug use among adults. Twenty-eight studies published between 1990 and 2015 were included in the review, 17 of which found that the psychological distress associated with economic recessions and unemployment was a significant factor. According to the authors:16
“The current evidence is in line with the hypothesis that drug use increases in times of recession because unemployment increases psychological distress which increases drug use. During times of recession, psychological support for those who lost their job and are vulnerable to drug use (relapse) is likely to be important.”
Pandemic May Lead to 75,000 ‘Deaths of Despair’
In a report by the Well Being Trust (WBT) and the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, it’s estimated that up to 75,000 people may die during the COVID-19 pandemic from drug or alcohol misuse and suicide. These “deaths of despair” are expected to be exacerbated by three factors already at play:17
Unprecedented economic failure paired with massive unemployment
Mandated social isolation for months and possible residual isolation for years
Uncertainty caused by the sudden emergence of a novel, previously unknown microbe
In order to come up with their 75,000 figure, the study used data on deaths of despair from 2018 as a baseline, projected levels of unemployment from 2020 to 2029 and then used economic modeling to estimate the additional number of deaths annually. Nine different scenarios were tested, ranging from quick recovery to slow recovery.
In the best-case scenario, 27,644 deaths of despair were estimated while in the worst-case example, 154,037 deaths could occur. While 75,000 was deemed to be “most likely,” the researchers noted, “When considering the negative impact of isolation and uncertainty, a higher estimate may be more accurate.”18
“Undeniably policymakers must place a large focus on mitigating the effects of COVID. However, if the country continues to ignore the collateral damage — specifically our nation’s mental health — we will not come out of this stronger,” Benjamin F. Miller, PsyD, chief strategy officer of WBT, said in a news release.19
A commentary by Dr. Jeffrey A. Lieberman, a psychiatrist with Columbia University’s department of psychiatry, similarly suggested a mental health crisis is looming.20 “The sobering reality is that high-quality mental health care is not available to most people,” Lieberman wrote. “This lack of strategy and access is especially concerning amid disasters such as COVID-19, which can cause considerable psychological trauma.”
Prolonged Isolation May Lead to Drug Abuse
As mentioned, prolonged isolation only exacerbates the issue. “The stressors from the pandemic are very, very real and how we cope with these stressors varies enormously,” Volkow told ABC News. “Social isolation is one of the factors that leads [people with substance abuse disorder] … to take drugs, and social isolation leads them to relapse, and the social isolation leads them to continue taking them.”21
With weeks of extended isolation already logged for most Americans, some communities are already reporting a rise in drug overdose deaths. Jacksonville, Florida, for instance, had a 20% increase in overdose emergency calls in March 2020.
Four counties in New York State also reported a rise in overdoses, while Columbus, Ohio, had a surge in overdose deaths, including 12 over a 24-hour period the first week of April.22
Whether overdose deaths are increasing across the U.S. is unknown, as Volkow noted that with COVID-19 shutdowns, collecting reliable data is difficult. However, a spokesperson for the U.S. Centers for Disease Control and Prevention told ABC News that officials are “aware of the concerns involving COVID-19 and drug overdoses and that it could affect some populations with substance use disorders.”23
Experts are recommending increased resources for people struggling with drug addiction, including access to online meetings. Remember that even if you’re socially isolated at home, you can reach out to friends and loved ones via phone or online. Connecting with others, even virtually, can help you to feel less alone. It’s also a good idea to set a limit on watching the news or browsing social media, especially if it increases anxious feelings.24
Original Source: articles.mercola.com
The People’s Republic of China set 2020 as the year it aims to eradicate absolute poverty nationwide. Rapid economic growth has lifted more than 850 million people out of absolute poverty since the beginning of economic reforms in the late 1970s, contributing to about 70% of worldwide poverty reduction. It has not yet announced final poverty figures for the year, but the official poverty rate had fallen to 1.7% of the rural population by 2018. The country’s achievement in poverty eradication must count as one of the most remarkable achievements in modern history.
The country has placed agriculture, farmers, and rural areas (three nong) at the core of its policy agenda to achieve the goal of a moderately prosperous society (xiao kang). Comprehensive rural development policy has supported remarkable growth in agricultural productivity and boosted off-farm income, which now accounts for more than 70% of rural household income.
Four features of rural development in the People’s Republic of China provide particularly important lessons for developing countries in Asia.
Flexible policies: The government adjusted rural development policy strategies to fit rapidly evolving socio-economic situations. For example, the No.1 Central Document has been annually updating the policy priority for rural development for each of the last 14 years. The initial policy reform in the late 1970s focused on boosting food production and maintaining grain self-sufficiency. The policy evolved in the mid-1990s to increase competitiveness of the rural economy through agricultural modernization and diversification of economic activities. Since the 2010’s, rural policy has shifted to a more integrated and balanced approach to improve economic, social and environmental welfare in rural areas. Support to agriculture was also gradually refocused from maintaining grain self-sufficiency to ensuring long-term food security through sustainable use of natural resources.
Innovative institutions. Innovations were introduced in rural land use and the reorganization of small-scale farms. A Household Responsibility System that originated in the late 1970s allocated land contract rights to individual households. This initial reform boosted agriculture production in the early 1980s, but created a small and fragmented farm structure. Since the 2000s, a variety of institutional innovations consolidated small scale operations into larger units. The holders of land contract rights were allowed to lease out their land operational rights.
The emergence of farm mechanization service providers enabled small-scale farmers to quickly mechanize their cultivation activities without heavy capital investment. Mechanization reduced labor input for farming and increased time available for engaging in off-farm income opportunities. Voluntary cooperative organizations provided a range of services to connect small-scale farmers to markets and the latest technologies through training, and collective marketing and inputs supply. Some co-operative organizations consolidated land operational rights from the member farmers to form a single farm management unit. All these institutional innovations are highly relevant for other countries with a small and fragmented farm structure.
Four takeaways from the stunning decrease in poverty in the People’s Republic of China.
Infrastructure investments. Network infrastructure investments in rural areas included roads, the telephone system, and internet on top of developing basic agricultural infrastructure such as irrigation and drainage. It connected farmers to markets and enabled manufacturing and service industries to develop in rural areas. High penetration of internet and mobile networks in rural areas accelerated the application of information and communications technology. E-commerce platforms such as Taobao have been essential in connecting farmers to end-consumers and oriented agriculture to be more demand-driven.
E-commerce has played a significant role in maintaining food supply chains during the COVID-19 pandemic. Beyond providing a platform for transactions, e-commerce platforms invested in logistics and marketing infrastructure and provided training for farmers to adopt new technologies. Growing engagement of tech companies in rural development is providing a new model of development led by the private sector.
Strong social protection. Rural health insurance and pensions have improved since the early 2000s to help bridge the gap with the urban social protection system. A rural minimum basic living guarantee (Dibao) provides an unconditional cash transfer to the poor (6.2% of the rural population as of April 2019). An expanded social protection system has improved the quality of life in rural areas, and assisted aged farmers to retire and transfer their farm assets to more efficient operators.
Despite remarkable progress in rural development, the People’s Republic of China still faces challenges. The per capita income of urban households remains more than 2.5 times that of rural households. The rural population continues to decline and is set to age rapidly. The expansion of agricultural production has been driven by intensive use of chemicals. Economic growth in rural areas can no longer be achieved at the expense of sustainable use of natural resources and requires more resilience to climate change.
Going forward, enhancing environmental welfare is key for rural areas to be attractive places to live, visit, and launch entrepreneurial activities. To that end, more investment is needed in rural environmental infrastructure, such as waste management, landscape and eco-tourism facilities. Public and private sectors can work together to make better use of underutilized rural resources including organic waste and by-products to generate new economic activity and improve environmental management. With continuing reforms, the People’s Republic of China is positioned to play a leading role in establishing a model of sustainable rural development in Asia and the Pacific.
China, PRC, People's Republic of China, rice field, agricultural activites, agriculture, farmer, farmers, paddie, rice, woman, Women, poverty, economics, farming, developmentShingo KimuraCountries: China, People's Republic ofArticle
Original Source: blogs.adb.org