The COVID pandemic has me confused with various state health departments, the CDC, the WHO, and hospitals repeatedly changing mask guidelines/mask requirements. Furthermore, I’ve had many patients complain about anxiety over both the pandemic and about masks and vaccines and their loss of autonomy in terms of being required to wear masks and/or take vaccines to enter buildings and keep their jobs respectively. And this is even though I keep telling them about how many COVID patients I have seen on ventilators in the inpatient units.
Colleagues tend to rely on me for advice regarding patients with substance abuse issues, anxiety/depression-related issues, and legal issues due to my history of substance abuse and criminal problems due to substance abuse.
One morning last year, I got a call from a colleague asking for advice regarding a patient who is both a cannabis and heroin addict and has been found unconscious multiple times and goes in and out of the medical hospital due to respiratory depression and other complications from heroin use. (After all, heroin is more dangerous than cannabis.) My colleague told me that his patient is asking him for a medical exemption from the mask requirement since masks give him anxiety and remind him of how his big brother used to suffocate him during fights when he was a child.
The patient also said that he is using more cannabis and heroin than normal due to anxiety from the COVID pandemic and promised he would cut down his heroin use if he could get the mask exemption letter. When my colleague asked me what to do, I responded that I am not sure exactly how COVID mask exemption letters work but that the patient “is probably more likely to die from a heroin overdose than from COVID.” After all, pt was vehemently refusing to go to drug rehab.
Looking back a year later, what I stated was true: The patient ended up dying from a heroin overdose despite my colleague writing the letter he wanted and the patient promising to cut down on his heroin. So I guess the COVID mask requirement wasn’t the only stressor driving his increased cannabis and heroin use.
And as for my colleague, he is now overwhelmed by the volume of patients at his clinic asking for vaccine and mask exemptions. It is almost like he opened a can of worms by giving out a few exemption letters in the first place.
On the one hand, we are battling a pandemic. On the other hand, the masks and vaccines worsen people’s anxiety and take away their autonomy. My advice is to be careful if you are an outpatient physician and asked to write a letter for a mask or vaccine exemption.
Louis J. Riccardo is a family physician.
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