Balancing the COVID Pandemic and the Opioid Epidemic

Tony Ferrese

In his book, The Wounded Storyteller, Arthur Frank discusses different types of narratives relating to storytellers dealing with illness. One of these narrative types surrounds an interruption in the teller’s life. Franks says, “In the beginning is an interruption. Disease interrupts a life, and illness then means living with perpetual interruption” (56). Frank explains that “telling an interrupted life requires a new kind of narrative” (58). He calls this the “chaos narrative.” The chaos narrative does not have a plot, as the story “is told as the storyteller experiences life: without sequence or discernible causality” (97). We could all consider our stories interrupted by the COVID-19 pandemic, with our narratives becoming those of chaos, out of our control with no ending discernible. The chaos story centers on someone “imprisoned in the frustrated needs of the moment,” the “person living the chaos story… has no reflective grasp on it,” and thus chaos “stories cannot literally be told but can only be lived” (98). This is the moment that we are in, where we can only focus on what unknown will come next, when we will get through this and be able to reflect on this time in a meaningful way. As Frank says, “To turn chaos into a verbal story is to have some reflective grasp of it—chaos is retrospectively remediated” (97, 100). I spoke with a woman, named Amy,[1] who tells her story of living with the pandemic, and she brings up a compelling point about the balance between the Coronavirus pandemic and the Opioid epidemic, both of which could be considered chaos narratives. This story chronicles one person’s chaos narrative, so that one day we can take all these stories and make sense of the world during and after COVID-19.

Amy lives in the Charleston area with her husband and two dogs. After earning her bachelor’s degree from the College of Charleston, she went on to earn a master’s degree from LSU, and she is now enrolled in a PhD program at Oregon State University. When news of the virus broke, Amy says she “wasn’t as concerned” as she “should have been.” Soon, though, when “Dr. Fauci came to prominence” and “became the symbol of COVID knowledge,” she began to pay more attention. She says that she got most of her information from news outlets, such as CNN and The New York Times, and she soon realized it was a “global issue” and that “we were getting close to our own outbreak” here in the U.S. Even with this information, she says the virus was “still mysterious at the beginning.”  Amy is an “avid believer in science” and “trusts the experts,” and she was aware that the virus “became politicized early on.” She knew the virus “had harmful respiratory effects” and was glad when mask wearing “became more normalized.”  She works with an agency as a therapist treating alcohol and drug addiction, as well as seeing individual clients with a range of mental health issues. It is because of this occupation that Amy offers a different perspective on the pandemic than most of us are exposed to.

Though her personal life was impacted by the pandemic- she loved travelling, going to restaurants and movie theaters, and socializing with her friends (she says she was fortunate to be able to occasionally visit with some of them, saying, with a quiet laugh, “we’re doing, like, adult sleepovers”), and attending weekly yoga classes at the local YMCA- it was Amy’s work life that was the most affected, for her and for her clients. The conversation about her job began as I asked her about discussing differing opinions on the virus. She says she “has to have conversations with a variety of different people from different walks of life” and “regularly encounters people with differing opinions,” but she says, “All I can do is just have an open and candid conversation about why they believe what they do, what the potential ramifications are. We have to have that unconditional personal regard, something that we practice in the field that I may not practice in my personal life.” But Amy seems to truly care about her clients. Working with people struggling with alcohol and drug addiction, and those with a variety of mental illnesses, she saw a heightened impact of the pandemic ripping through those communities. She says, “When people get anxious or have to isolate themselves, that has a huge effect on the people I work with, they tend to get a little fearful, paranoid. Isolation tends to do that to people. But people with drug problems or alcohol problems, it has been exacerbated by the pandemic.”

I asked about the initial impact of the virus on her job and workplace, wondering how seriously her management responded, what protocols they put in place, and asking if any of her clients or colleagues contracted the virus. She says, “It’s hard to keep track of time now. It’s like there were different seasons of Coronavirus.” During this time of confusion and chaos, her agency was dealt a devastating blow. One of her colleagues contracted the virus early on. Amy explains how this all came about. “She already had a lot of health issues,” she says. “She was older, she was in her late sixties, she had been in recovery for fifteen years, she was our peer support specialist, and she had some chronic health conditions, respiratory issues. She had to go and get surgery done for her back; she was having issues with Crohn’s disease. She went into the rehabilitation center following her surgery, and we think that’s where she was exposed to COVID-19. Unfortunately, she passed away. She was in the rehabilitation center for about a week, her health deteriorated, they had her in ICU for another week, then she was moved to what amounted to end-of-life care, and she didn’t make it.” I asked how she received the news of her colleague’s untimely death, and she said that she was notified by another colleague about the situation. “Within an hour,” she says, “I got the official call from my supervisor. An email was sent out to everyone; it was a weird thing.”  Amy’s colleague “had already been gone for a period of time” before the shutdown, so they didn’t think much about it, until they found out “she was never coming back.”

Amy says, “We were really affected by it. Our clients were really affected by it. Her office was right next to mine, so that was really challenging. At the time, we didn’t have any protocols in place. We didn’t know what the hell we were doing. She didn’t get [the virus] in our facility, but it really reiterated to management the importance of putting those protocols in place that we can protect people.” Amy says that “it was a huge blow” to their agency, that it “became a little more personal at that point.” She says, “We would get a little angry when people weren’t using the precautions or taking it seriously because that was part of the reason our friend and colleague died.” About her clients, Amy says, “I think that really hit home for [them] as well.” Obviously, whenever there is such a loss, a personal tragedy, there is a grieving process following the event. Amy says this, too, was impacted by the pandemic. She says during the grieving process, for most people, “it’s better to be together, to talk about things.” But this was not the case for Amy and her colleagues. She says, “Coming from a therapeutic environment, we know how challenging the grieving process can be, especially in isolation.” She says, “We’re all in our houses, and we hear that our good friend and our colleague is gone. It just didn’t seem real to many of us… It wasn’t something that our agency was prepared for, that any agency is really prepared for.”

In addition to the isolation and the loss of a beloved mentor for her clients, Amy says there have been a “lot of changes” in how her agency provides services. Amy conducted groupwork with her clients, consisting of “seven to twelve people on average” at a time, and at the start of the shutdown, “group services entirely went away for a while.” She was “only able to provide individual services until the Telehealth platform was off the ground.” She explains that her agency “can’t use things like Zoom because it’s not HIPA compliant.” Eventually, they were able to do some groups, but she still finds it “extremely frustrating.” She explains that “there is a variety of different issues that can occur” in an “online group environment, including WIFI issues, people not paying attention, kids running around, cats running across the screen, people eating and smoking cigarettes,” but “at a certain point, they did get more used to it.” She says, “we will never get to a point where we prefer it, but it became more tolerable for us clinicians and for the clients as well.”

I asked her whether the ability to do her job was impacted, if she was able to provide the same level of care, and Amy hesitated and said, “Well, research shows that Telehealth sessions tend to be as good as in person sessions, but from my experience and working with the population that I work with, it’s really difficult, especially with substance use, to be able to deliver the level of care that we need to. For the longest period of time, we were unable to drug test people. We were seeing extremely high rates of overdose. We were seeing increased rates of hospitalization with our clients because there is less accountability. Anybody can appear on screen and say that they’re not doing drugs or drinking. I just have to take their word for it; I can’t administer a drug test over the internet. I miss a lot of signs and signals that would be a lot clearer in person, so it got very dangerous and anxiety-provoking for a while there.” This topic brings up a very interesting aspect to the pandemic that, like in our typical lives, is under exposed: what about those with mental health and/or addiction issues? I expect there will be studies in the future that will address this issue, exploring the impact on these communities, how the pandemic impacted people struggling with addiction, especially in Amy’s field. It must be a difficult thing to balance. Another notable impact for her clients was that, toward the beginning of the pandemic, they could not send clients to inpatient treatment as they normally would. Amy says, “The facilities required negative COVID tests, and at that point testing was much harder to come by.” Many of those inpatient facilities are still shut down.

In addition to the issues relating to remote therapy sessions, Amy’s agency was in the process of relocating when the pandemic struck. This posed even more problems for her agency as well as their clients. She says that when everything shut down, she had to work completely remotely, then they were able to work from the office, and eventually were able to have clients come in on a very limited basis. She also says that they were eventually able to resume some drug screening after finally being able to move into the new building. Her agency thought the move would only take a few weeks before they could resume seeing clients, but “it turned out to be a few months,” which Amy attributes to “stricter guidelines implemented by DHEC,” which needed to approve the now location. Plus, the agency had to figure out “what new protocols to put in place in their new location in order to keep people safe.” Since the incident with her colleague, Amy’s agency has implemented much more stringent precautionary measures. She says her supervisor even “walked around with a pool noodle that was six feet, just to make sure the seating distance was exact,” but, she says, “It has greatly limited the number of people we can see at one time.” “Honestly,” she says, “something is better than nothing at this point.”

I asked Amy what happens next. She told me that DHEC finally approved her agency to see in-person clients “two or three weeks” before my interview with Amy (conducted on November 29, 2020) on a one-on-one basis. Amy says that they “just started assessments last week,” which is essentially the intake process for new clients. This means that, since the initial lockdown, not only has there been less adequate care for clients, but those who have needed help since the pandemic hit were simply out of luck. Amy says, “I know they are trying to balance everything with the greater good of the community at large, but it’s difficult.” She says that they “just started groups again, for intensive outpatient care, which is the highest level of need for the clients” that they treat. “We really wanted to get them back in,” she says, “because they are the highest risk for overdose and hospitalization.” She says it is sort of like their “pilot group,” but that “it’s just bad timing because the numbers are going up again.”

I asked Amy if she felt prepared, considering the current trend of rising cases. She says, “I don’t know if prepared is the right word. I feel different than I did in the beginning because we’ve learned a lot more about [the virus], about how it manifests, how it spreads, the symptoms, and most importantly how to treat it.” She says that she feels better that “the mortality rates have gone down, even as the cases have gone up,” but, she says, “Still, we are approaching a scary place.” She says she hopes we will be able to control the spread of the virus in the coming months, but she knows there are issues with mask wearing. “Unfortunately,” she says, “mask wearing has become a political issue, and it shouldn’t be. It shouldn’t have ever been.” Overall, though, she says, “I’ve tried to remain eternally optimistic.” She believes a safe vaccine is on the horizon and that the people working on the vaccines “genuinely want this to go away, and they don’t want to hurt anybody.” She says, “I trust in the process, and in the fact that, to the best of their abilities, these pharmaceutical companies are going to run as many trials as they need to and test [the vaccine] in an ethical way. I believe the people that are working to make this happen have our best interest in mind.”

About the next steps at her job, Amy says, “I was really eager to get back to in-person treatment, but the timing hasn’t been the best. At the same time, I understand the agency needs to make money. If they don’t make money, they can’t pay me, and we can’t treat anybody if we close down.” She says, “I think it’s been really challenging striking that balance between how to still provide service to our clients and still make the money we need to run a business… and do it safely.” Her agency has invested money in air filtration systems, masks, and cleaning products. Amy says that her boss even invested money into a disinfectant smoke machine. “I appreciate the efforts they’re making and the money they’ve invested,” she says, “but I know, too, that they’ve lost a lot of money… with the Telehealth services, plus the decreased level of care that we can provide.”

Amy’s work life was the most significantly impacted aspect of the pandemic, for her and for her clients. About her experience with the pandemic and moving forward from here, she says, “It’s been hard. I’m still concerned, but I’m less fearful than I was in the beginning because we have more knowledge. But I know it’s still something that we need to address appropriately.” Part of the issue, as Amy sees it, is that her agency can take all the necessary precautions, but, she says, “We don’t know what other people are doing. We can’t control that.” For Amy, we are talking about two different deadly scenarios: The Coronavirus and Addiction. Balance is tough during a pandemic, especially when considering the community Amy serves. Do you save a life that may or may not die later, that may or may not become infected, or do you save lives that need to be saved right now? To me, thinking about it in terms of striking a balance is an insightful and effective way of considering Amy’s world. On one hand, the people she cares for are already at risk, and an underserved community, generally. On the other hand, there is a deadly virus and the risk of an outbreak. It does seem that they have a handle on it and are taking extra steps to attempt to tow that line, providing much needed services and care, while doing everything they can to practice safe procedures.

Amy vocalizes her perspective quite eloquently at the end of our interview. She says, “I realize the Coronavirus pandemic is going on, but the Opioid epidemic has been going on much longer. It’s killing a lot of people, and that has been accelerated because of the quarantine and the shutdowns and increased depression and anxiety and hopelessness. A lot of attention needed to be paid to the pandemic and still needs to, but, from my perspective, seeing people in such a dangerous place was almost scarier to me at the time.”







Work Cited

Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. The University of Chicago

Press, Chicago, IL, 2013.


[1] Her name has been changed for anonymity, and some of the material quoted from the interview has been edited for clarity, with most filler words removed.