Bringing Out the Worst in Each Other: COVID-19 and Opioid Use Disorder

The COVID-19 pandemic is raising concerns about the medical and psychological implications for those with Substance Use Disorders (SUD), in particular, Opioid Use Disorder (OUD). A White House drug policy office analysis indicates an 11.4% increase in overdose fatalities in the first four months of 2020, compared to the same time last year. Non-fatal overdoses have increased by 18.6% in the same time frame. [I] Individual states have seen even higher numbers. Kentucky estimates that they have had a 25% increase in overdose deaths between January and March. [II] Health officials looking at the medical components of both diseases and historical drug use during crises are seeing troubling patterns.  

Opioid use could hinder COVID-19 recovery and COVID-19 could raise the risks of opioid use. Due to the negative impacts of opioid use on lung and heart health, people who use opioids in high doses could be more susceptible to getting COVID-19 and more likely to have severe symptoms.[III] While the effects of opioids and COVID-19, like many other co-morbidities of COVID-19, need to be further studied, the NIH is voicing concerns about the unique challenges for those with OUD. It has been studied that chronic respiratory disease can increase deadly overdose risks among opioid users and the diminished lung capacity from COVID-19 is creating stark parallels.[IV]  

Social distancing and border shutdowns are also increasing the dangers of physical drug usage. Those who are social distancing and do not have a family member to give them naloxone if an overdose occurs, or to seek medical attention, could result in higher fatalities from opioid overdoses. The break down in the drug supply chain across state and national borders led some to be optimistic that there would be a decrease in overdoses due to a decrease in supply. However, the opposite appears to be occurring. Without access to normal supply chains, drug users are seeking out new, unfamiliar suppliers and substances, increasing the risk of overdose and death. [V]

The psychological impacts of COVID-19 are also furthering the burden for those with OUD. Social isolation is a risk factor for relapse for those recovering from a SUD. [VI] Social distancing can pose challenges for those in recovery by limiting their interactions with peer-support groups and face-to-face interactions that are a part of their recovery plan. Virtual meetings can be put in place to mitigate the negative effects of social distancing, enabling recovering users to obtain sources of social interaction built for their recovery. That being said, the replacement of in-person interaction with therapy via virtual platforms and its effects on recovering drug users has yet to be fully studied during the pandemic.  

Concerns about the economic crisis are translating into concerns over drug usage and a potential lack of available treatment. The economic implications of the virus point to an additional increase in usage due to the connection between opioid use and economic and social upheaval. [VII] The economic impacts of the coronavirus pandemic are putting treatment centers at financial risk, bolstering what experts claim is an already underfunded treatment infrastructure. [VII] With COVID-19 putting on hold most non-COVID related work at NIH, a billion-dollar research program for new forms of addiction treatment is currently at a standstill. [IX]   

It could be months before more definitive and comprehensive numbers exist to demonstrate the true impact of the COVID-19 crisis on the number of drug overdoses and OUD. Not all states have reported their numbers, but unofficial reports and expert observations are pointing to similar patterns across the nation. The numbers that have already come in are painting a troubling picture for those already battling a life-threatening illness, an illness silently increasing due to the COVID-19 pandemic.