For most jurisdictions where they were legal, alcohol and marijuana were available at every stage of the pandemic. In North America, the shops selling marijuana and alcohol were deemed an “essential service” which meant that they were open throughout the pandemic, in the same way as grocery stores and pharmacies were open.
Even in news reports, it was noted that a reason for liquor stores being deemed “essential” was that it was a public health measure. There were a certain number of people who were addicted to alcohol and, if they were not able to get it, they might go into withdrawal necessitating health measures which might be in short supply at the height of the pandemic. Certainly, back in March 2020 when these decisions were made, there was a justifiably great fear of hospital emergency rooms being overwhelmed, as they had been in Italy. There was not exactly a dialogue but there was public acknowledgement and tacit public acceptance. Were there not also many who were certainly not addicted to alcohol but who realized that they might find themselves in need of a stiff drink or a glass of cold white wine at the end of a difficult day in “our new normal”?
There was not even this much discussion raised about marijuana. Some people use it as medication, don’t they? I mean, a lot of reports say it’s not even addictive. What about those reports that it causes schizophrenia? You’d probably have to use a lot to cause schizophrenia. Well, it’s legal now. These were the kinds of statements that I heard from friends, acquaintances, my young adult patients and parents. These are not discussion points. They are almost questions and very good questions, but they are not questions that address what marijuana addiction (technically, Cannabis Use Disorder) is or how to know whether your own or a loved one’s use of marijuana is problematic.
With “social distancing” firmly in place, we became used to lining up for grocery stores, but the lineups for liquor and marijuana stores were surprising to many, although they did confirm that many people saw liquor and marijuana as substances they required. The period of isolation was stressful: working from home while you helped your kids with their homework or tried to look after a toddler or worried about your mother who was struggling to manage months in the tiny room of her retirement residence. Many of us had days when we used alcohol or marijuana at the end of the day to relax, to turn off our minds so we could rest. Many parents may even have looked the other way when the teen or young adult in their home, even if they were “a bit” under the legal age, did the same.
But, how and when do we talk about overuse and addiction as a society? Did public health agencies have time amidst the COVID-19 updates to consider the risk that increased stress might cause problematic alcohol and marijuana use? What about other drugs?
To think about how we discuss, in public and private dialogues or groups, our personal drug and alcohol use and when we might worry about it, look at some of my wording in the paragraphs above. I have deliberately used language that demonstrates our discomfort with discussions about addiction. It takes a lot of practice to be comfortable speaking with someone about addiction – and if you’re really comfortable with it, you likely are a health professional with a lot of practice. But it is a lot of practice. I am still uncomfortable talking about addiction in some circumstances and I have been doing this for forty years!
Talking about addiction is difficult and you risk being hurt when you start a discussion with someone whose drug use worries you. These are the kinds of things people might say after you ask one gentle question about their drug use:
“Are you calling me an alcoholic?”
“You think I’m just one step away from being a junkie?”
These are the questions that can trap any well-intentioned person and push them away from a discussion. It is because these questions are so difficult that those of us who are just trying to help need guidance from public health to foster a harm reduction dialogue with our loved ones.
What we have seen emerge from public health experts about addiction over the course of the pandemic is related to the opioid crisis. The impact of opioid use is perhaps the most acute and the most serious of the addictions we have seen in the last four months because of the increase in overdoses and deaths. There was already a public health crisis related to opioids before the pandemic and this has worsened during the pandemic. There is no doubt that this must be addressed.
At the same time, and within months, as our world opens up and some people continue to use more alcohol and marijuana than they had before, many of us will need to have that larger conversation about drug and alcohol use and how much is too much. There is a lot of good information that is evidence – based in the public domain, but, when you’re facing a personal crisis, it helps to find reliable information if some online or TV ad has drummed it into your head or popped up on a screen a hundred times. Those kinds of messages, in well-travelled media spaces, really boost a public health campaign.
For those people needing to start these conversations with a loved one, I really like the advice given in this short article about communicating about drug use. But, even more, I’d like that public health campaign, please.