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Melissa Harris-Perry: This is The Takeaway. I'm Melissa Harris-Perry in for Tanzina Vega. On Wednesday, the CDC released a troubling statistic. In 2020, more than 93,000 people in the US died from drug overdoses. 93,000, that's a nearly 30% increase from the previous year. That's the biggest increase in around five decades according to Politico.

Experts say that the isolation and depression that so many experienced during the pandemic likely played a significant role in the spike in overdose deaths. We reached out to our listeners about this and here's how the overdose crisis has affected some of you.

Kay: My name is Kay and I live in Petaluma. I'm a school teacher and I lost one student, overdosed about three weeks after lockdown, and then a second one two weeks later. The second one survived, but the first did not. We were all just shattered and are still shattered.

Ursula: I'm Ursula calling from St. Louis, Missouri. I have been affected by the overdose crisis. I'm 26. I have lost count of how many friends I've lost to overdose. At least one friend a year overdoses and dies and it never gets any easier. Knowing my friends have died defendable deaths is so maddening. I carry Narcan with me everywhere I go and I hope that I never have to use it.

Marceline Brown: Hi. My name is Marceline Brown. I'm calling from Salt Lake City, Utah. My beautiful 27-year-old son Jack died on December 12th, 2020 from an accidental overdose that contained fentanyl. Earlier in the evening of the night he died, he came over to my house to get his birth certificate, and he was very excited. He was going to start a new job.

He wasn't high when he came by, he looked healthy and happy. He gave me a big hug like he always does and said, "I love you, mom". I hugged him back as he was leaving and said, "I love you too. Be careful," and he said, "We'll do," and gave me that beautiful smile I will never forget. The next morning, the police knocked on my door. Apparently, the horrific sound and scream of the grief escaping my body was heard through the neighborhood, and I don't know, because I don't remember.

The grief will extend generations. Two months after his death and 24 hours before what would have been his 28th birthday, his daughter was born. He never got to see her or hold her. She'll never meet her father. My life is forever changed and I don't know how to reconcile all of this unnecessary trauma and grief.

Melissa Harris-Perry: We are so grateful to you for sharing with us and please know The Takeaway family considers each of your stories to be special and each of your losses to be meaningful.

Earlier this week, President Joe Biden nominated Dr. Raul Gupta to lead The Office of National Drug Council Policy, which would make him the country's top official dealing with the opioid epidemic. Dr. Gupta has experience working on the opioid crisis in West Virginia. However, some public health advocates have been critical of him for not doing more to prevent the closure of the syringe exchange program in Charleston, West Virginia during his time as the state's public health commissioner.

If Dr. Gupta's confirmed, he'll be one of many public health officials faced with the urgent task of figuring out how to reduce drug overdoses. Understanding the overdose crisis we're in and whether there are any clear solutions is where we start today.

With me now, is Usha Lee McFarling, National Science Correspondent for STAT. Usha, thank you for being here.

Usha Lee McFarling: Thank you.

Melissa Harris-Perry: Also with us is Linda Sacco, Chief Clinical Officer of Phoenix House, which is a nonprofit drug rehabilitation organization operating in 10 states. Linda, great to have you here as well.

Linda Sacco: Thank you for having me, Melissa.

Melissa Harris-Perry: Usha, as we heard in that heartbreaking story from Marceline from Salt Lake City, it feels as though this grief and loss is so unnecessary. Can you talk to me about what harm reduction is?

Usha Lee McFarling: Well, harm reduction is trying to get opioid preventive drugs to people, trying to get substance abuse treatment to people, meeting them where they are. These programs occur in cities across the US and they're critical and these are things that were almost completely shut down as the rest of the country was when the pandemic started last March.

Melissa Harris-Perry: Take us into that moment just a bit more to the start of the pandemic. What did most harm reduction programs do when those lockdowns began around the country?

Usha Lee McFarling: Well, I think people were stunned in all sectors of the country and some very valiantly tried to persist and go on and meet people. I spoke with workers from Prevention Point in Philadelphia that work in some of the hardest-hit areas of that city. They work out of vans, they work in small storefronts. A lot of those outreach workers got COVID just as they tried to do their work.

These programs they couldn't bring people into residential settings as they had, people were scared, people were on lockdown so people just were really hard to reach. Seven-step programs like AA and Narcotics Anonymous, those could not meet in person. A lot of people were just left without any resources.

Melissa Harris-Perry: Now, Linda, what did that mean for patients to lose those harm reduction and inpatient and other support programs?

Linda Sacco: Well, as we like to say, the opposite of addiction is connection, and losing those really, really important connections for people created so much isolation and disruption in life, they couldn't see their families. As Usha said, 12-step programs were closed, MAT programs might've been closed to get their medication. People really dug in, it made getting into recovery and remaining in recovery really difficult.

We know many people who may not have been diagnosed with a substance use or mental health issue before the pandemic have reported increasing their substance use, their drinking, their smoking as a way to cope with that stress and isolation.

Melissa Harris-Perry: Do the data tell us anything about-- because I think there were different kinds of experiences of isolation. For some folks, it was literally being isolated from everyone, home alone for days and weeks and months on end. For other folks, it meant being isolated but isolated with, for example, children or spouses or parents. I'm wondering if data tell us anything at this point about what kinds of social isolation might've been most related, Linda, to these overdoses?

Linda Sacco: It's really all kinds of isolation that when you disrupt somebody's life, what they're used to, it can really exacerbate any symptoms or any problems that were there before. Folks that might've been struggling, maybe they were just getting by. They had a job, their children were in school, suddenly they're working from home, the children are at home, money becomes very tight, people in the family were dying so it was just all of those things swirling around together that just threw everybody really off their normal.

Melissa Harris-Perry: Usha, obviously there were a wide variety of areas and sectors of the economy that were able to pivot to online, but is that something that was possible for substance abuse treatment programs?

Usha Lee McFarling: It was and I would say there was some really heroic efforts to get virtual visits for people, to get people back into inpatient care that they needed through testing. There was a lot of creativity. There were also some really progressive changes made to-- Previously when people wanted methadone or their substance abuse medication, they had to come in daily. Some rural patients could drive an hour or more. Can you imagine going daily for your doctor for your diabetes or cholesterol medicine? During the pandemic, they allowed people to get longer prescriptions for weeks instead of daily and some of those virtual really helped.

Melissa Harris-Perry: Usha, I'm going to stop right there for just-- stop right there for just one second and help me to understand why when you make that point about your diabetes medication or something else, why is it that patients who needed methadone were required to come every day?

Usha Lee McFarling: Well, Linda might want to comment, but it's considered a drug and there is a risk of abuse or sharing the drug with someone else. I think studies have shown that those risks are very low and they're certainly much lower than the risk of overdose if you don't have access to your medicine and if there's an interruption in getting that medicine, you can feel very sick. You can go into withdrawal and then you can turn back to the drug that you're trying to avoid. There's a lot more risk to not giving people a steady supply of their medication and during the pandemic, a lot of the steady supply was not there.

Melissa Harris-Perry: Linda, I'm wondering if part of what I'm hearing from Usha, and again, just trying to piece these pieces together, was this-- certainly, there's a burden on patients who have to arrive every day, but I'm wondering if there's also a burden on the system for that kind of daily medication process. Was the system prior to the start of the pandemic already overburdened?

Linda Sacco: The system was definitely overburdened. There was a workforce crisis in behavioral health services long before the pandemic workforce shortages, underfunded, very difficult. During that pandemic, so there are folks, as Usha said, that go still for their methadone daily. It took a little bit for clinics to really figure out how to change over and be able to give some-- they call it take-home medications to clients, figuring out where and how they could manage that.

There are also regulations for other types of medications. Prior to the pandemic, Usha mentioned buprenorphine earlier, the first visit for buprenorphine had to be in person. So anybody coming at the beginning of the pandemic, wanting to start treatment they couldn't find that.

Still in this country, 50% of the counties in the US do not have a doctor or a nurse practitioner that is permitted under federal law to prescribe buprenorphine, they have to go and get extra training. It's called they get a DEA data waiver. There's a lot of barriers in front of people to get that medication for addiction treatment. During the pandemic, that all just got harder, it was harder and harder to access for people.

Melissa Harris-Perry: Linda, can you say something about the particular drugs. I know that that for you in this process, you rolled the drug names off the tip of your tongue, but help us to understand if there are particular drugs that people were using and what fentanyl is, sort of its role in all of this.

Linda Sacco: Sure. Fentanyl is a large contributor to the fact that this has been the largest overdose deaths ever recorded in a 12 month period. It's 50 times more potent than heroin. It takes three times the Narcan to reduce an overdose if there's fentanyl involved. What's happening, it's been mixed in with other drugs. Many people know fentanyl is deadly, they wouldn't touch it by choice, maybe they were using some cocaine, some methamphetamine.

What's been happening over the last year, fentanyl is being mixed in with things so that the person taking their drug of choice whether it's cocaine, methamphetamine, something else, even heroin, had fentanyl mixed in with it, and they did not know what they were taking.

Melissa Harris-Perry: If I went to the store and bought a bottle of wine, and there was poison mixed into it, we wouldn't understand then having an overdose from wine as being a choice that I was making as a wine drinker?

Linda Sacco: Exactly. It's exactly the same. They just didn't know. People started, they came up with testing kits. In some states, people were given these testing strips so that if you bought drugs, especially from someone you didn't know, you could test it and find out if there was fentanyl in it, and then make your choice to use it or not to use it, and they instructed the clients who took these strips, leave the strip near where you are because if you have an overdose, they'll at least know that you had fentanyl and know better how to help you. Very scary.

Melissa Harris-Perry: I want to come to you, Usha. When we are talking about people and people overdosing, who are we talking about? Are these younger folks, older folks, Southerners, Northerners, is there a racial demographic, who has been most impacted?

Usha Lee McFarling: It's safe to say that it's everyone. You would have wealthy employers, housewives, suburban school kids, people experiencing homelessness, its people in rural areas and urban areas. I'll also say that these numbers, these deaths, tragic as they are, I think they come as a surprise to precisely no one who's following this area.

You already had a drug epidemic that was out of control because of fentanyl, and then you had the pandemic ushering isolation, depression, grief, economic hardship, these are all known triggers for substance abuse and overdose. The combination has just been explosive.

Melissa Harris-Perry: Usha, in some sectors, areas, the pandemic, for all the horror that it was, also produced some creative policymaking that now some folks are trying to keep now that the pandemic is beginning, hopefully, to wind down a bit. I'm wondering if there were changes made during the pandemic to substance abuse treatments that could continue?

Usha Lee McFarling: Well, yes, I think so. We talked about patients being able to grab their take-homes, as they call them, so they don't have to come to the clinic every day. I think there's also a loosening to allow more people to prescribe substance abuse medication without going through all those loopholes and the extensive training that was needed before and a lot of the virtual visits, but I think we have to remember that these are benefits that may not benefit everyone.

If you have a good internet connection and can reach your doctor, that's fine, but we had many people who were trying to say go to an AA meeting on Zoom and they didn't have Wi-Fi so they're Zooming in from the McDonald's parking lot. I spoke with clinicians who said they had people that only spoke Spanish that went to all Spanish AA meetings. A lot of these did not translate to Zoom. Technology and innovation will certainly help but it's not going to help everyone.

Usha Lee McFarling: That's so helpful to think about it in those very specific contexts. Linda, what is one of the biggest things that we can do right now that will help to address this increase at least in the immediate future?

Linda Sacco: I think we really need to keep plugging away the stigma that is still attached to seeking treatment for substance use disorder. It really is a disorder like any other medical disorder, and there shouldn't be any shame in having an addiction issue or seeking treatment for it. In-person and virtual services, as we said, are available and people who need it should seek help now. No one really needs to be alone in this struggle, treatment works and it's available. To try to pull that stigma away and treat this-- as Usha said, if you had diabetes, you wouldn't feel ashamed to go and get treatment.

Melissa Harris-Perry: When you talk about the stigma, Linda, I'm wondering not only about that's the individual stigma or shame that a person may feel to go and get the treatment but I'm also so interested in your point about the testing strips being available, or this critique right now of the person who will now be in charge of the federal level, from West Virginia, not making sure that one of the syringe exchanges remained open. I wonder about how shame and stigma also impact the policymaking that we do.

Linda Sacco: They definitely do. I think there's still that feeling sometimes that people who have an addiction who get into this situation have done so willingly because they're bad, because-- a lot of reasons for doing this and we never really think about this is an illness like any other. We would not refuse a diabetic their insulin because they're eating cake but yet, sometimes, substance use disorder treatment is hard to access for people because of stigma, because we still sometimes think of this as a moral failing, or refusal to get better.

Melissa Harris-Perry: Usha, I'm interested if part of the horror of this is, as you pointed out, the ways that it impacts across all these demographic groups, but might that also be precisely the opening our possibility for political change that if this isn't just about poor folks, or white folks or brown folks or rural folks, but impacting all these different kinds of families, might we be able to see a coalition come forward to pressure for real public policy change on this?

Usha Lee McFarling: I would hope so. As we heard from your listeners, these stories are heartbreaking. They affect all of us, and they affect all of our families. I think the problem with the pandemic was public health officials were strapped and they took their eyes off this and we can never take our eyes off this. This is another epidemic. No matter what happens going forward, we really have to address it. All of us can help. I think, as Linda does, everyone should carry a can of Narcan, you never know it might be your boss, might be your high school principal, you might be able to save a life.

Melissa Harris-Perry: Linda, just to go back to the origins, can you help us understand how it is that people often find themselves addicted to these drugs?

Linda Sacco: There are many ways. There are sometimes folks who have this in their family, they start using alcohol or a drug and then become addicted. There's a biological connection there. Other times it's a reaction to stress. Somebody just starts drinking, it relieves their stress so we drink more. When that no longer helps you to feel better about that stress, you might turn to another substance.

Melissa Harris-Perry: If someone finds themselves in a situation of being a parent, a loved one, a friend, what's the first step in that moment?

Linda Sacco: The first step I think is making sure that you're not promoting stigma against this disorder. This is nothing that you should be hiding from the rest of your family. Bring it out in the open and look for help immediately.

Melissa Harris-Perry: Linda Sacco is the Chief Clinical Officer for Phoenix House, and Usha Lee McFarling is a National Science Correspondent for STAT. I'm so grateful to both of you for being here today.

Linda Sacco: Thank you.

Usha Lee McFarling: Thank you.

Melissa Harris-Perry: If you or someone you know is struggling with substance abuse, you can call the Substance Abuse and Mental Health Services Administration's national helpline at 1-800-662-4357. Once again, that's 1-800-662-4357.

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