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Mental Health in 2021: The Year in Review

The year in review – a rundown of notable findings and news in mental health in 2021, including statistics, research, reform, and legislation passed.

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According to USA Today, a poll that asked Americans to describe 2021 in one word indicated that the year was overwhelmingly bleak for many. The top five most common responses were:

Awful/terrible/bad/sucked (23%)
Chaos/confusing/turmoil (12%)
Challenging/hard/rough (11%)
Disaster/train wreck/catastrophe (6%)
Okay/good (6%)

How were such dismal views reflected in mental health in 2021? Who was impacted the most and why? What helped Americans cope?

This article reviews American mental health in 2021 – a rundown of last year’s notable research findings, statistics, and events.

Mental Health in 2021: Statistics & News

According to a 2021 Mental Health America report, the top-ranking states for overall mental wellbeing (based on rates of mental illness and access to care) are:

5) Connecticut
4) Pennsylvania
3) New Jersey
2) Vermont
1) Massachusetts

The lowest ranking states are: Wyoming, Alaska, Arizona, Idaho, and Nevada (with Nevada at the bottom).

January 5 – Ketamine shows promise as a treatment for chronic PTSD by reducing symptom severity. Click here to read the study abstract. (Source: American Journal of Psychiatry)

April 1 – The Standard reports that 49% of American workers struggled with alcohol and substance use in 2020. Read the full article.

April 6 – Research indicates mental health complications in survivors of COVID-19 persist up to 6 months and beyond post-infection. (Source: Lancet Psychiatry)

April 15 – Psilocybin, the hallucinogenic chemical in ‘magic mushrooms,’ is found to be as effective for treating depression as a common antidepressant. (Source: The New England Journal of Medicine)

April 22 – 3 in 10 healthcare workers consider leaving the profession due to pandemic-related burnout. (Source: The Washington Post)

July 13 – Over half (53%) of United States public health workers report symptoms of depression, anxiety, post-traumatic stress disorder (PTSD), or suicidal thoughts since the start of the COVID-19 pandemic according to the CDC.

July 23 – Mental health workers are deployed to provide mental health support to first responders, the search and rescue teams, who worked for weeks to find victims after the condo collapse in Surfside, FL that killed nearly 100 people.

November 1 – Aaron Beck, the father of cognitive therapy, dies at 100. (Source: USA Today)

December 13 – Digital (computer and smartphone-based) treatments for mental illness may effectively reduce symptoms of depression. (Source: American Psychological Association)

December 17 – Rates of depression and anxiety increased globally during the pandemic. (Source: Psychiatry Advisor)

December 21 – The American Psychiatric Association endorses the Well Beings Mental Health Language Guide intended to address stigma around mental illness and provide readers with person-centered language. Read the news release.

Suicide is the second leading cause of death for individuals between the ages of 10 and 34 in the United States. (CDC)

A 2021 report published by Mental Health America indicates that most American employees are experiencing burnout. Furthermore, employees are not receiving the support they need to manage stress; workplace stress has a significant impact on mental health. Download the full report here.

At the end of 2020, 1 in 5 adolescents as well as 1 in 5 adults reported that the pandemic has negatively impacted their mental health. (Source: 2020 National Survey on Drug Use and Health)

Addiction & Recovery

The 2020 National Survey on Drug Use and Health indicates that nearly 60% of Americans use drugs and/or alcohol with over 20% of the population reporting illicit drug use.

January 1 – A study published in Drug and Alcohol Dependence estimates that the opioid crisis cost the economy over $1 trillion in the United States in 2017.

February 28 – According to a growing body of research, Topamax continues to show promise as a pharmacological treatment for alcohol use disorder. (Source: Neuropsychopharmacology)

June 12 – The anti-inflammatory drug ibudilast shows promise as a treatment for alcohol use disorder. A small study found that it decreased heavy drinking. (Source: Translational Psychiatry)

June 25 – Research suggests that life achievements are linked to sustained recovery. (Source: Journal of the Society of Psychologists in Addictive Behaviors)

July 5 – A pilot study indicates that high-dose gabapentin therapy may reduce harmful alcohol consumption. (Source: Alcoholism, Clinical and Experimental Research)

July 21 – Wearable devices measure and track stress reactions to help to prevent relapse. Read the article from Washington State University Insider here.

August 3 – Alcohol consumption is linked to nearly 750,000 cancer cases in 2020. (Source: CBS News)

September 27 – Yale researchers predict that graphic photos showing the severe consequences of smoking, which will be printed on all cigarette packages in the U.S. beginning October 2022, will save an estimated 539,000 lives. (Source: Yale News)

November 30 – Researchers explore nutritional ketosis as a treatment for alcohol use disorder. (Source: Frontiers in Psychiatry)

December 5 – TMS therapy reduces cravings and heavy drinking days. (Source: Biological Psychiatry)

December 17 – Researchers predict that a one-year increase in alcohol consumption in the U.S. during the COVID-19 pandemic will cause 8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure, and 1,000 cases of liver cancer by 2040. (Source: Massachusetts General Hospital)

Overdose Statistics & News

In 2019 there were 70,630 primarily opioid-involved drug overdose deaths in the United States. 72.9% of opioid-involved overdose deaths involved synthetic opioids. (Source: CDC)

The states with the highest overdose death rates are:

5) Pennsylvania
4) Maryland
3) Ohio
2) Delaware
1) West Virginia

February 3 – Researchers develop experimental vaccines to block opioid-induced respiratory depression, the primary cause of overdose death. (Source: Scripps Research Institute)

February 17 – Demi Lovato reveals that she suffered from three strokes and a heart attack in 2018 as a result of a drug overdose, leaving her with permanent brain damage. (Source: ABC News)

March 4 – A 75-year old New York doctor who saw patients in a hotel parking lot is charged with murder for 5 opioid deaths after writing massive quantities of prescriptions for opioid drugs. (Source: CSB News)

April 2 – The CDC reports that overdose deaths were at their highest in 2020, a 38.4% increase compared to the previous 12-year period.

September 1 – Purdue Pharma, the maker of the highly addictive painkiller OxyContin, is dissolved in a bankruptcy settlement that requires the company’s owners, members of the Sackler family, to pay billions of dollars to address the impact of the opioid epidemic. (Source: New York Times)

September 9 – Disparities in opioid overdose deaths for Black people continue to worsen. Read the press release. (Source: National Institutes of Health-NIH)

September 22 – An NIH report indicates that methamphetamine-involved overdose deaths nearly tripled between 2015-2019. Read the press release.

October 28 – The American Medical Association commends the Biden-Harris Administration “for responding to the spike in drug overdoses with an evidence-based, humane approach to increasing access to care for patients with a substance use disorder and harm reduction services.”

November 22 – Researchers develop a wearable naloxone injector device to detect and reverse opioid overdose. Read the news release from UW Medicine.

December 1 – Fentanyl strips prevent overdose and save lives. (Source: MSN News)

December 7 – The first safe injection sites in America open in New York in Washington Heights and East Harlem. (Source: Psychiatry Advisor)

December 9 – The Metropolitan Museum of Art in New York announces it is dropping the name of the philanthropic Sackler family, whose name is linked to America’s opioid epidemic. (Source: NBC News)

Discrimination & Reform

January 18 – The American Psychiatric Association issues a public apology for their past discriminatory practices. Read the news release here.

February 25 – The House passes the Equality Act, which “prohibits discrimination based on sex, sexual orientation, and gender identity in areas including public accommodations and facilities, education, federal funding, employment, housing, credit, and the jury system.”

March 3 – The House passes the George Floyd Justice in Policing Act of 2021.

March 10 – The Emmett Till and Will Brown Justice for Victims of Lynching Act of 2021, a bill that establishes lynching as a federal hate crime, is introduced in the House.

April 8 – The CDC director declares racism a serious public health threat. (Read the media statement here.) The American Medical Association releases a response statement applauding the CDC.

May 1 – A study indicates there are significant increases in anxiety among Black emerging adults from exposure to police violence. (Source: American Psychiatric Association)

June 1 – Research establishes a link between substance misuse and transgender-related discrimination.

July 30 – Research suggests that a 2017 executive order banning foreign nationals from select Muslim-majority countries from traveling to the United States harmed the health of Muslim Americans. (Source: Yale News)

August 17 – Researchers find persistent racial and ethnic health disparities in the United States. (Source: JAMA)

October 29 – The American Psychological Association issues an apology for its longstanding contributions to systemic racism.

December 1 – A study indicates that youth who face discrimination are at a greater risk for developing a mental disorder and are twice as likely to experience severe psychological distress compared to youth who don’t experience discrimination. (Source: Pediatrics)

Mental Health in 2021 Legislation

In February, the Mental Health Justice Act of 2021 to create a grant program for training and dispatching mental health professionals (instead of law enforcement officers) to respond to psychiatric emergencies is introduced.

The House passes the Violence Against Women Act Reauthorization Act of 2021 in March.

In May, the House passes:

Family Support Services for Addiction Act of 2021 to expand services for individuals with substance use disorders and their families
Improving Mental Health Access from the Emergency Department Act of 2021 to improve services for patients experiencing psychiatric emergencies
Campaign to Prevent Suicide Act to increase suicide prevention resources

Also in May, the Senate passes the Improving Mental Health Access for Students Act to increase suicide prevention resources for students.

On October 26th, the House passes the Family Violence Prevention and Services Improvement Act of 2021 to expand services for victims of domestic violence.

The infrastructure act signed to law by the president in November mandates automakers to install anti-drunk driving technology systems in all new cars.

In 2021, recreational marijuana use is legalized in New York, Virginia, New Mexico, and Connecticut. While marijuana is still federally controlled, it is now legal in 19 states and the District of Columbia and medically allowed in 36 states. Read more about marijuana legalization in the United States here. (Source: U.S. News)

The States Reform Act to end federal prohibition of cannabis is introduced in November, and a Florida representative submits a legislative proposal to decriminalize all illegal drugs.

Mental Health in 2021: Conclusion

2021 – the second year marked by the COVID-19 pandemic – brought with it more distress, loss, and hardship, with no end in sight as COVID deaths in 2021 surpassed those in 2020. While the year delivered a few legislative victories and promising research findings in mental health in 2021, overall, it wasn’t a great one.

Data suggests that mental health in 2021 suffered, with increased rates of depression, anxiety, and substance use. Healthcare workers experienced severe burnout. Overdose deaths skyrocketed while thousands of lawsuits were filed against opioid makers such as Purdue Pharma who started and sustained the opioid crisis in America, profiting off the suffering and tragedy of addiction. (See the Opioid Settlement Tracker to learn more about opioid settlements and how the money is spent.)

Meanwhile, a wave of civil unrest in America, triggered by the murder of George Floyd in 2020, continued into 2021 with protests, rioting, and violence. While the movement gained strength in 2020, in 2021, many Americans looked away. At the same time, there was a political push for a more “patriotic” retelling of history – to limit what schools could teach about slavery. However, steps in the right direction were taken by both the American Psychiatric Association and the American Psychological Association when they issued public apologies for the harm they caused.

Although drug overdose deaths increased, there were significant strides taken in 2021 to win the “war on drugs” – by ending it with an awareness that this is not a war; it’s a treatable illness. 2021 saw the establishment of evidence-based, harm-reduction measures as well as legislation to decriminalize and legalize drugs. Meanwhile, medical research in 2021 revealed promising treatments to heal both addiction and mental illness.

To conclude, last year – in general – sucked. Despite this, it wasn’t entirely bad in mental health in 2021. And, 2022 could be the light at the end of the tunnel! In fact, the same poll that suggested 2021 was a “trainwreck” of a year found a majority of Americans are still hopeful for 2022.

“We must accept finite disappointment, but never lose infinite hope.”
Martin Luther King, Jr.

Kratom: A Safe Alternative to Heroin?

Kratom is a tropical tree native to Southeast Asia. It’s becoming increasingly popular in the United States. It’s used for pain relief, mood enhancement, and to manage opioid withdrawal symptoms or reduce/stop opioid use. This post explores the use of kratom as a potential treatment for opioid use disorder.

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Kratom (mitragyna speciosa) is a tropical tree native to Southeast Asia and, like coffee, is part of the Rubiaceae plant family. Ingesting the leaves produces a high. Taken in small amounts, it leads to stimulant-like effects (i.e. increased energy and focus – stronger than caffeine, less intense than cocaine). When taken in larger doses, the high is similar to that of an opioid (euphoria, drowsiness, “pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is unique in that it produces both stimulant and opioid-like effects.

Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.

In the United States, kratom users cite pain relief as a primary motive for use. It’s an opioid agonist, and works by binding to opioid receptors in the brain. It can be effective for both acute and chronic pain. Others report using kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.

Kratom is legal in Virginia; it’s sold at vape or “head” shops as a loose powder or in capsules. (Alternatively, kratom can be purchased online.) Packaging is typically labeled “botanical sample only; not for human consumption.” The extremely bitter powder can be sprinkled over food or brewed into a tea. It’s easily swallowed in capsule form.

What does kratom mean for the opioid epidemic in America? Will it one day play a key role in the treatment of opioid use disorders? Or will it fall into the “harm reduction” category? Is it a natural pain medication, a safe alternative to highly addictive opioid pain killers?

Or, will we find that kratom, like heroin, is habit-forming and deadly? Currently, the research is mixed.

An Alternative to Opioid Drugs

The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom effective for relieving pain, reducing opioid use, and easing withdrawal symptoms.

In 2011, researchers discovered that kratom alleviated morphine withdrawal symptoms. A more recent study indicated that it may reduce morphine use.

Earlier this year, researchers found that kratom use was associated with significant decreases in the occurrence and severity of opioid adverse effects; it lessened the discomfort of opioid withdrawal. Multiple studies have substantiated these findings, suggesting that it could be a useful medication for opioid addiction and withdrawal.

Interestingly, in 2007, it was found that kratom reduced alcohol withdrawal behaviors. More recently, researchers discovered that it was associated with decreased alcohol use; this suggests that it may help those with alcohol use disorders (AUD) in addition to opioid addiction.

Harm-Reduction

Compared to heroin, kratom is less addictive and has milder withdrawal symptoms. Furthermore, the risk of overdose is low. A 2018 literature review indicated that it may have harm-reduction potential for individuals who want to stop using opioids.

Dangerous & Addictive?

According to the CDC, there were 152 kratom-involved deaths between July 2016 and December 2018 (“kratom-involved,” meaning it was a factor). In seven of those deaths, kratom was the only substance found in toxicology tests (although it should be noted that the presence of other substances was not fully ruled out). It’s possible to overdose on kratom, and when combined with other drugs or medications, it can be fatal.

In rare cases, kratom has been linked to liver toxicity, kidney damage, and seizures. In the case of a 32-year-old woman who was using it for opioid withdrawal, it was likely the cause of acute lung injury. Use may also cause cardiac or respiratory arrest.

Kratom’s harmful effects are not limited to the body; a 2010 study linked chronic use to alterations in working memory. In 2016, researchers found that kratom use was associated with cognitive impairment. An additional 2016 study supported previous findings that it may affect learning. In 2019, researchers found that high doses were linked to memory deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive impairment. That same year, researchers found that long-term kratom use did not appear to cause altered brain structures. More research is needed in this area.

Regarding whether or not kratom is addictive, multiple studies have found that regular use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.

Bottom Line

Will kratom step up as the hero of today’s opioid epidemic? Doubtful. And for kratom to be a viable treatment option, more conclusive research is needed. Additionally, researchers must study the safety of long-term use.

While it’s unlikely, kratom use could lead to adverse health effects or cognitive impairment; it could also fatally interact with other substances or medications. Furthermore, long-term use may lead to addiction. In sum, the majority of the literature suggests that kratom is, by no means, safe.

That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use it to reduce/stop their opioid use, I’ll view it as harm-reduction. Until we have more answers, I will hold to the harm-reduction view… it has the potential to save lives.

References
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#JunkieLivesDontMatter

Many believe that addiction is choice and that individuals who use drugs are just “junkies” – and #JunkieLivesDontMatter.

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This article is inspired, in part, by an ignorant (not ill-intended) meme posted by a healthcare worker on social media.

The meme said,

“So if a kid has an allergic reaction the parents have to pay a ridiculous price for an Epi pen. But a junkie who has OD’d for their 15^th time gets Narcan for free? What a screwed up world we live in.”

Implication: A “junkie” doesn’t deserve a second chance at life. (#JunkieLivesDontMatter) They’re a waste of resources because they lack the willpower to stop using. A person with a substance use disorder is choosing that life. Why interfere? (Especially when all that money could be spent saving more deserving lives.)

If you believe it is screwed up for a “junkie” to have a chance at life (and recovery) because they “chose addiction,” your opinion is contrary to the National Institute of Health, the American Medical Association, the American Psychiatric Association, and decades of scientific research. You’re also a part of the movement: #JunkieLivesDontMatter

Many have joined the movement, as evidenced by the following social media posts:

“Out of all of the houses, 2 hobos decided to overdose on my front steps… thank god the medics got here in time to ensure they could die another day…”

“I think we had less ODs before Narcan came on board. They realize they can be saved if gotten to in time. Maybe they need to be locked up & not let out until they attend rehab while in jail.”

“If it can be easily established that they have a recent history of drug [abuse]… then yes… withhold the lifesaving drug because they chose this. It’s harsh, but justice is not served by saving them.”

“If you don’t have it figured [out] by the 3^rd overdose, you are just prolonging the inevitable and wasting tax payers money.”

“If we are repeatedly saving your life and you are not willing to change this behavior, why should we be obligated to keep saving you?”

“My personal opinion is we can’t keep letting people overdose and saving them just so they can repeat the cycle.”

“By continuously administering Narcan, sure, we’re saving their life, but are they really living? I don’t think so.”

#JunkieLivesDontMatter

#JunkieLivesDontMatter: Addiction & Stigma

According to the American Psychiatric Association,

Addiction is a complex condition, a brain disease that is manifested by compulsive substance use despite harmful consequence. People with addiction (severe substance use disorder) have an intense focus on using a certain substance(s), such as alcohol or drugs, to the point that it takes over their life. They keep using alcohol or a drug even when they know it will cause problems.

Addiction is a scientifically-proven brain disease. Despite this, many persist in the belief that it’s a choice, or worse… a moral failing.

The notion comes from an early model of addiction, “the moral model,” which was deeply rooted in religion. Addiction was attributed to a sinful nature and weakness of character. Therefore, the addict must repent… or suffer the consequences of his/her actions; addiction warranted punishment, not empathy. Unsurprisingly, this created stigma. It also prevented those struggling with addiction from seeking treatment.

Centuries later, many hold on to the view that an individual suffering from a substance use disorder is lazy or weak… or a worthless junkie.

Today, in the midst of the opioid epidemic, stigma’s unrelenting grip perseveres. Stigma is a poison; it’s dehumanizing. It’s easy to forget a person is a person when you view them as garbage, trash… a “junkie.” Stigma tells us, “Take out the trash.” #JunkieLivesDontMatter

To fully recognize stigma’s impact, compare addiction to other diseases. Consider common medical emergencies; many are related to lifestyle. Imagine being hospitalized after your third stroke, and the doctor telling you, “This is the third time I’ve saved your life, yet you refuse to exercise. I shouldn’t be obligated to continue to provide life-saving care.” Or, imagine a long-time smoker who develops lung cancer; they’re not demeaned, called names, or denied treatment.

Moreover, an EMS worker wouldn’t withhold CPR from an individual in cardiac arrest if they were obese. It’s not a debate.