We Can’t Let COVID-19 Halt Our Progress With the Opioid Epidemic
By: Rachael Cooper, senior program manager for substance use harm prevention safety at the National Safety Council
In 2018, we saw a glimpse of good news after years of tragic developments in the opioid epidemic: the United States experienced a slight decrease (4.1%) in overdose fatalities (67,367) from 2017 (70,237)[1]. It wasn’t a miraculous turnaround, but it was evidence that we were heading in the right direction.
Unfortunately, like so many other issues, the COVID-19 pandemic threatens to undo the incremental progress we were making.
Since the start of the pandemic, opioid overdose fatalities have been rising across the country, with increases documented from Wisconsin to Florida, from Texas to New York. While it is too early to say if these fatalities are a direct result of the pandemic (e.g. decreased service capacity, increased isolation, etc.), there are certain impacts from our response to COVID-19 that have the potential to negatively affect people who have an opioid use disorder, increase risk for overdose and pose challenges for people in recovery.
Epidemic disruptions
With our nation’s focus on doing whatever it took to address the COVID-19 pandemic in the previous months, many essential services were impacted. Decreased accessibility to treatment services, increased service interruptions, limitations in harm reduction services like syringe exchanges and naloxone provision programs, as well as a lack of access to prevention programming may have all contributed to the rise in overdose deaths we are now seeing, and may continue to impact the opioid overdose rates moving forward.
Navigating over-worked and thinly stretched social support systems such as foodbanks, shelters, unemployment agencies, job centers and other community support programs is also significantly more difficult than it was only a few months ago. This can disproportionately impact people with an opioid use disorder, who often have co-occurring disorders and are at a higher risk of experiencing homelessness.[2] Individuals with an opioid use disorder who were incarcerated and are now reentering society (already at a significantly higher risk for a fatal opioid overdose) may be especially impacted by these roadblocks. As the pandemic continues, we must remember that economic distress, vulnerability and unemployment are all linked to increases in substance use.[3]
Isolation issues
For those in recovery, the physical and social isolation imposed by the pandemic can create many additional burdens. Even with the advent of recovery technologies and apps, far too many people face hurdles in accessing those types of support, including people who are experiencing homelessness, people without easy internet access and older adults who are less familiar with technology.[4]
Isolation is similarly dangerous for those who are using opioids, as isolation conditions can exacerbate substance use disorders.[5] Also, if people are using opioids alone, there is no one to call 911 in the event of an overdose. Even if people are using together, they may be less likely to call 911 due to fears related to COVID-19, and overburdened paramedics may not get to the scene as quickly.
The extreme stress most Americans are experiencing impacts how family and friends handle the opioid crisis, as well. Family members and friends may be unable to offer the same level of support to loved ones struggling with addiction. Looking to the future, we must remember that stress and unstable housing and financial situations are risk factors for developing a substance use disorder later in life.
Actions to take
Though it is likely that we will not fully understand the impact of COVID-19 on the opioid epidemic for years to come, there are actions we can take to help. Certain measures have already been implemented to increase support services, such as major insurers starting to cover telemedicine addiction services.
The Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Agency (DEA) have relaxed some regulations on medications for addiction treatment (MAT), letting providers do initial intakes and prescribe buprenorphine over the phone and allowing patients to take home 14–28 days’ worth of medications to reduce time spent in a clinic.[6] Although these changes are allowed and encouraged, many more addiction treatment centers and clinics could implement them. Similarly, efforts must be made to increase access to telemedicine, which is new for many providers and patients alike.
Another key intervention is the continued availability of naloxone (the medication that temporarily halts an opioid overdose) for people who use opioids. Fortunately, many community-based organizations, pharmacies and counties have scaled up their efforts to get naloxone to those in most need, including drop-off and mailing services.
Finally, workers across the country should expect their employers to address substance misuse in the workplace, too. Policies and procedures for assisting employees struggling with opioid misuse should be implemented as part of every effective return-to-work strategy.
As the COVID-19 pandemic changes our daily lives, keep in mind that many people close to you may not feel these impacts on their mental health or substance use for many weeks or months. We should all make efforts to check in with our loved ones, friends, co-workers and neighbors during this exceptionally difficult time. Keep communicating via text, call or video chat, whether it is to offer compassion or ask for help when you need it. Simply being available can help save someone’s life.
[1] https://www.cdc.gov/mmwr/volumes/69/wr/mm6911a4.htm?s_cid=mm6911a4_w&deliveryName=DM23288
[2] https://www.nationalgeographic.com/science/2020/04/coronavirus-pandemic-may-fuel-the-next-wave-of-the-opioid-crisis/#close
[3] https://annals.org/aim/fullarticle/2764311/epidemic-midst-pandemic-opioid-use-disorder-covid-19
[4] https://www.shatterproof.org/blog/moving-addiction-treatment-online-right-thing-do-could-leave-most-vulnerable-without-care
[5] https://khn.org/news/addiction-is-a-disease-of-isolation-so-pandemic-puts-recovery-at-risk/
