COVID-19’s Impact on Substance Use Disorder

We are living in strange times. As I write, the COVID-19 pandemic that began in early 2020, leading to stay-at-home orders, quarantines, and school and business closures has resulted in over 52,000 infections and over 740 deaths in Maine. The development and FDA emergency use authorization of multiple vaccines against the devastating disease has led to optimism that we may be turning a corner in our fight against the coronavirus. We all want to get back to normal, to a world where we don’t have to worry quite so much about the health and safety of our family and friends, but as we look to a future out of the woods of COVID-19, we must also look to recommit to the fight against the opioid crisis that has been exacerbated by the pandemic and our response.


As Dr. Nicholas Nissen writes for ABC News, “Opioid overdoses have been on the rise as the COVID-19 pandemic has taken center stage. Rather than existing separately, there appears to be an interplay between COVID-19 and addictions.” Not only are people with substance use disorders more susceptible to COVID-19 hospitalization and death, the prevalence of overdose and overdose death have increased throughout the pandemic. Stress, anxiety, and isolation that are a byproduct of our response have combined with new and old barriers to treatment to create a perfect storm for the opioid crisis to worsen.


The numbers are startling:


● COVID-19 patients with substance use disorder were more likely to be hospitalized or die from the infection (41.0% versus 30.1% and 9.6% versus 6.6%, respectively).

The CDC reports that in the year ending in July of 2020, coinciding with the COVID-19 pandemic, overdose deaths increased by 25 percent compared to the year ending in July of 2019.

Surveillance data show that reported overdoses (fatal and non-fatal) increased by over 16 percent in the first months of the pandemic.

In 2020, calls to the U.S. Substance Abuse and Mental Health Services’ crisis hotline increased by 700 percent compared to 2019.


“Another point to consider is that the pandemic took away the attention—from the media, from legislators, from public health agencies—that was being focused on the opioid crisis,” writes Chris Sweeney of the Harvard T.H. Chan School of Public Health. “We have an addiction crisis in the U.S. that was being discussed quite a bit in 2019 and it seemed like we were starting to inch toward policy solutions.”


The Rx Abuse Leadership Initiative of Maine (or RALI) and our partners across the states have continued our efforts to address these challenges throughout the pandemic. Now, we must all turn our attention back to fighting the opioid crisis. Luckily, there are things every one of us can do to be a part of the solution.


Increased COVID-19 Risk Among People with Substance Use Disorders


One of the more frightening aspects of these overlapping health crises is that, according to the National Institutes of Health (NIH), addiction appears to make people more susceptible to getting COVID-19 and more likely to experience the worst health outcomes associated with it – hospitalization and death. Additionally, for more complex reasons, the pandemic appears to be contributing to higher overdose death rates.


In fall of last year, a study funded by NIH found that people with addiction are more “revealed that those with a recent SUD diagnosis on record were more likely than those without to develop COVID-19, an effect that was strongest for opioid use disorder, followed by tobacco use disorder.” In the study of 73 million patients, 10.3 percent had a substance use disorder (SUD), but they represented 15.6 percent of COVID-19 cases. Those with a diagnosed substance use disorder were more likely to develop COVID-19, and the increase in infection rates was highest among those with opioid use disorder. COVID-19 patients with addiction also suffered higher rates of hospitalizations and deaths (41.0% versus 30.1% and 9.6% versus 6.6%, respectively).


Increase in Overdose Death Rates Amidst COVID-19


At the same time as patients with SUD were at greater risk for severe COVID-19 and death, drug overdoses resulted in 453 deaths in the twelve months ending in July 2020, an increase of over 40 percent over the twelve months ending in July 2019. From March through May of 2020, at the outset of the pandemic, the Overdose Detection Mapping Application Program (ODMAP) showed a 16.56 percent increase nationally in reported overdoses once stay-at-home orders were implemented.


COVID-19 Responses & Implications Down the Road


First, isolation, loneliness, and stress associated with social distancing, fear of infection, job losses, and other changes brought on by the pandemic contribute to higher rates of use. According to Dr. Nora Volkow, Director of the U.S. National Institute on Drug Abuse, “During the pandemic, more people are experiencing anxiety. More people are experiencing depression. And one of the ways that people cope with depression and anxiety is taking drugs.” This means that people who were already using drugs may be using more, people who were not using drugs may begin to use them, and people who were in recovery from addiction may be relapsing and using again. This points to the potential that not only will we experience current higher rates of use and overdose, but that we may also see that COVID-19 has planted the seeds for higher future rates of substance use.


Given both increased stress, anxiety, and isolation, as well as increased drug and alcohol use to cope with these difficult feelings, it’s no surprise that in 2020, calls to the U.S. Substance Abuse and Mental Health Services’ crisis hotline increased by 700 percent compared to 2019.


Another way in which COVID-19 may be contributing to higher rates of overdose death is that emergency help is less available. One response to the opioid crisis has been increased training and community-based distribution of the opioid overdose reversing medication naloxone. Research shows that when more people have and know how to use naloxone, overdose deaths decrease. However, if nobody is there to administer the lifesaving medication or call for emergency medical help, an overdose that might have been reversed can result in death. “People die from opioids when they use alone,” said Connecticut paramedic Peter Canning. Isolation and fear also prevent people from seeking emergency help when they need it. “[P]atients have likely died of overdoses because of concern of getting care when they need it and Covid-19 overtaking needed services,” writes Dr. Jessi Gold. “Amid surges in cases, hospitals are also full and emergency medical technicians overwhelmed with Covid-19 patients. This removes the lifeline for overdose reversal established over the opioid crisis and patients are unable to get urgent, lifesaving care.”


Finally, despite efforts to make SUD treatment more readily available amidst shut-down orders that prohibited in-person counseling, it has become more difficult for many people to engage with addiction treatment that may have been keeping them in recovery or would have helped them to get help if there were no pandemic. In the spring of 2019, federal regulators took steps to increase access to telehealth for addiction counseling and medication prescribing. They made it easier for patients to keep opioid use disorder medications at home. Yet as many as 20 percent of patients do not have a cell phone or internet access and telemedicine really only benefits patients if they have these tools.


What You Can Do To Help


Sometimes it feels like COVID-19 has taken away so much of our control over our lives. Thinking about the additional crisis of drug overdoses and addiction can be overwhelming, but there are things we can all do to help make our families and communities safer.


First, learn more about the risks of opioids and signs that someone in your family might be struggling with substance use. RALI has partnered with Code 3 to bring the RALI CARES educational experience to parents, grandparents, teachers, and caregivers across the country. The RALI CARES trailer is outfitted to look like a teenager's or young adult’s bedroom, but it is filled with hidden warning signs of substance misuse. As we remain socially distant, you can tour the virtual educational trailer to learn more.


You can also learn about naloxone and get trained to use it, especially if you know someone who may be at risk for opioid overdose.


Finally, reach out to people in your family, social circle, or community who may be struggling with loneliness, isolation, or anxiety during these challenging times. The more we support each other to cope with the stresses of COVID-19, the less we feel the need to rely on drugs or alcohol to manage these difficult emotions.


We’re finally turning the corner on COVID-19. As vaccinations continue to ramp up, it feels like the possibility that life will get back to normal is getting closer and closer. Now it’s time to recommit to the fight against addiction and overdose to build a healthier and more vibrant society for everyone.