Provisional Centers for Disease Control & Prevention (CDC) data show that U.S. drug overdose deaths increased by 30% in 2020 from the prior year, reaching an all-time high. Increases in overdose deaths were reported for synthetic opioids (primarily fentanyl), natural or semi-synthetic opioids (e.g., prescription pain medications), psychostimulants (e.g., methamphetamine), and cocaine. In many ways, COVID-19 has stymied efforts to provide substance use treatment access and overdose prevention.
The pandemic has led to intense feelings of stress and anxiety among many; in some instances, this has resulted in substance use as a method of coping with those feelings. CDC studies estimated approximately 41% of U.S. adults experienced any adverse mental health- or substance use-related event during the pandemic, while 13% specifically started or increased substance use. Eighteen to 24 year olds, Hispanic persons, and Black individuals were all more likely to report increased substance use.
Although further study is necessary to identify the exact causes of these higher rates of substance use and overdose, some potential factors may include: isolation and loneliness as a result of COVID-related quarantine or shutdowns; disruption of usual illicit drug supply chains resulting in use of new and potentially more dangerous suppliers or drugs; increases in income and housing insecurity as a consequence of the related economic downturn; and reduced access to high-quality, evidence-based care as service providers close or reduce hours and access for social distancing purposes. For more information on how the COVID-19 pandemic has impacted persons living with substance use and their providers, please visit this NAAG webinar.
Beyond risks of overdose, persons who use drugs (PWUD) are more susceptible to COVID-19 and related complications. In a National Institute of Drug Abuse (NIDA)-funded study, PWUD were disproportionately represented among COVID cases, particularly if they were living with an opioid use disorder (OUD). Individuals with a substance use disorder (SUD) were also more likely to be hospitalized and die from COVID than those without an SUD. PWUD often have compromised lungs and/or cardiovascular system which may help to explain why they are more vulnerable to COVID-19. In addition, because PWUD are frequently marginalized and stigmatized, they face challenges in accessing necessary health care services, including COVID-19 testing, prevention, and treatment.
The COVID-19 pandemic has challenged the health care system, including substance use treatment services, to evolve and innovate to meet the needs of the individuals they serve. In response to the COVID-19 public health emergency (PHE) declaration, the federal government changed some requirements for providers treating persons living with OUD so that providers and patients can follow social distancing guidelines. The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) allowed flexibilities for providers to prescribe buprenorphine and other controlled substances via telemedicine. This included allowing providers both inside and outside opioid treatment programs (OTPs) to initiate buprenorphine treatment for new patients over the telephone or using an audio-visual connection without requiring an in-person evaluation. This flexibility has resulted in increased access to buprenorphine for new and existing patients throughout the COVID-19 pandemic.
The changes and expansions in telehealth have also addressed long-standing challenges faced by people living with OUD in accessing treatment (e.g., lack of transportation, limited availability of providers). Phone-based telehealth services have especially allowed persons living in rural and urban settings without adequate broadband access to still receive the benefits of timely and continuous treatment. For additional information on substance use treatment flexibility in the COVID-19 pandemic, please view the NAGTRI online course.
For all the benefits that telehealth-based access to medications for opioid use disorder (MOUD) presents, it is not sufficient on its own to support the full complement of services that may benefit PWUD. First, some services PWUD utilize cannot be provided via telehealth (e.g., syringe service programs (SSPs)). Second, some PWUD may still benefit from in-person support, such as case management, for a variety of reasons, including lack of access to phone or audio-visual connections.
In the coming months, the U.S. health care and public health systems could face several challenges in meeting the needs of PWUD. They will have to develop or maintain the capacity to support the increased numbers of persons who use drugs and/or are living with substance use disorders following the beginning of the COVID-19 pandemic. This involves offering a variety of complex clinical and support services including, but not limited to, mental health services, substance use treatment, overdose prevention, housing support, and infectious disease prevention and treatment.
For more information on NAAG’s response to the COVID-19 pandemic and substance use, visit NAAG’s public health-related updates.