He was 41 when he died. And though he faced substance use disorder throughout his adult life, David was sober nearly the entire year leading up to the pandemic. When I saw him over dinner and donuts last November on a visit to Los Angeles, he was crushing life. I was proud of him. My handsome, charming big brother finally had it together. (Of course, even when he didn't have it "together," he was still my biggest champion.) David was thriving as a personal trainer at a gym. He loved being a dad and absolutely adored his little girl. Although they weren't living together at the time, he would text me most days with photos and videos of my niece. The last text he ever sent me on March 13 was a paraphrase of a quote he'd heard by myth scholar Joseph Campbell: "When you live a life for someone other than yourself, you are living a hero's journey," my brother wrote.
At that point in time, David was on the cusp of a promotion at work -- unless the coronavirus really hurt business, he cautioned our father. His promotion never happened. And neither did my promise to visit him and my niece in March. Instead came the pandemic, and with it, a perfect storm for relapse. In the six days after David texted me, everything keeping him on track and on the path of treatment was gone. When California's stay-at-home order took effect on March 19
, David was suddenly out of work, unable to visit his daughter, and without a support network.
We worried about him. David plus free time was historically a recipe for disaster. I should have checked in. Aside from an email he sent me on March 17, congratulating me for a new article I wrote that week, I hadn't heard from David. The updates about my niece stopped. I should have known something was wrong.
On the phone with our father an hour or so before we learned of my brother's death, our dad said to me, "I'm worried about David. I don't know what kind of trouble he's going to get into now that he's not working and can't see his daughter. I think he's been sleeping all day." He sounded worried. David wasn't returning his calls that day. That night, I received a Facebook message from David's landlord asking me to give him a call. Thinking, hoping that David owed rent money, I sent his number to our father. My dad called me back shortly after speaking with the landlord, with a message he had long dreaded delivering: "David passed away."
Nearly five months later, a report from the coroner's office confirmed my brother was one of the earliest Americans to die from opioids during the Covid-19 pandemic, but far from the last. More than 40 states have reported increases in opioid-related mortality, according to the American Medical Association
. Data from local and state governments collected by The New York Times
indicates that deaths from drug overdose in the US rose by an estimated 13% in the first half of 2020 compared with 2019. 2020 is on track to have the sharpest increase in drug deaths from the previous year since 2016, which coincided with the dawn of a new and deadlier era in the opioid crisis, the proliferation of fentanyls.
Yet, when history books tally Covid-19's tragedies, David is likely to be left off the official count. Instead, he'll be sectioned off as part of the opioid crisis. In reality, these crises are inextricably connected. President Donald Trump may not have created either, but his attacks on health care and his disregard for science exacerbates these dual crises. In the middle of a pandemic and an economic downturn, the President shamelessly continues his crusade against health care, science, compassion and kindness: some of the most powerful tools we have to treat Americans and society at large.
If he gets his way, the Supreme Court will soon have a sixth vote that could strike down all of the Affordable Care Act and permanently end Obamacare for roughly 20 million people, a devastating scenario for Americans with substance use disorder who rely on Medicaid.
The expansion of Medicare and Medicaid through the Affordable Care Act meant significantly more people with substance use disorder had access to insurance. As with other pre-existing conditions, substance use disorder could no longer be a reason for an insurance company to deny someone coverage.
shows the ACA extended health insurance benefits to 1.6 million previously uninsured people with substance use disorders. This matters. Adults with Medicaid who have substance use disorder are statistically more likely than those with other coverage to seek treatment, according to data
from 2017. This may include detox, in-patient and long-term residential rehab, outpatient treatment, and access to methadone clinics.
After a 2012 Supreme Court case allowed states to opt out of Medicaid expansion, 12 states
decided not to adopt expansion and two states
adopted but did not implement it. One study
published in the medical journal JAMA found that adoption of Medicaid expansion was associated with a 6% lower rate of opioid overdose deaths compared with the rate in states that did not expand.
The ACA as it currently stands is far from perfect -- but to repeal it without a replacement is a travesty any year, let alone in the middle of a pandemic and job crisis. The ACA was a game-changer for people with substance use disorder. Moreover, it has played a crucial role in narrowing
racial and ethnic health care disparities and inequalities for Black and Latinx Americans.
And Trump's ongoing attack on health care isn't the only way he is is actively harming people with substance use disorder. During the first presidential debate, his callous words
about Biden's surviving son, Hunter, threatened to further stigmatize addiction. "I don't know Beau. I know Hunter. Hunter got thrown out of the military. He was thrown out, dishonorably discharged for cocaine use," Trump falsely stated. Hunter Biden was in fact discharged
from the US Navy Reserve in 2014 after he failed a drug test for cocaine, but his discharge was administrative, not dishonorable. And while the President may view substance use disorder as a sign of weakness, the scientific community treats addiction as a medical condition. Because of the President's callousness and own moral failures, many more Americans are likely to die from this disease than otherwise would have.
A compassionate leader would acknowledge the pain and struggles of people impacted by substance use disorder. Trump made it a cruel and factless punch against his opponent.
It is entirely possible my brother would have died regardless of who was president, pandemic or no pandemic. It's also probable that no matter how hard he worked to fight his disease, forces outside his control mixed with his medical condition and created a tragedy. I will never know exactly what happened in the final week of my brother's life. Nor does it matter. He is never coming back. But while it is too late to save my brother, there are countless people out there who can still be saved.
Through kindness, compassion, and modern medicine, we can stop more senseless deaths and tragedies. But we need a president who will champion these values. We need a president who will treat our society with science, compassion, and kindness. When Americans cast their ballots this election, I hope they consider the many layers of loss during this moment. I hope they consider my brother.
If you or someone you know is struggling with addiction, there are resources and hotlines
available to help.