Colliding Epidemics of COVID-19 and Opioid Use Disorder Highlight Need for More Resources and Expanded Treatment
As cases of COVID-19 continue to spread across America, the effects of the pandemic on the opioid crisis are creating mounting concerns nationwide.
The Centers for Disease Control and Prevention (CDC) released provisional drug overdose death counts from 2019, which show that there were 70,980 reported deaths due to drug overdose -- a 4.6% increase compared to 2018 (67,850).2 Local reporting indicates an alarming growth in 2020 rates of fatal overdoses as well The Overdose Detection Mapping Application Program (ODMAP), which provides close to real-time tracking of overdose events across the country through inter-agency collaboration, found a 20 percent increase in suspected overdoses since the first reported case of COVID-19 in comparison to the same time frame in 2019.3 The data show suspected overdoses have increased 18 percent in March, 29 percent in April, and 42 percent in May in comparison to 2019.4
Addiction Policy Forum released a research report that detailed survey results of more than 1,000 patients, families, and individuals in recovery to examine the impact of COVID-19 on people impacted by substance use disorder (SUD). The research found that 20 percent reported increased substance use and 4 percent reported an overdose since the pandemic began. Additionally, 1 in 3 reported changes in treatment or recovery support services.1
Several localities nationwide have reported dangerous spikes in fatal overdoses during the pandemic. Franklin County, Ohio reported that the first four months of 2020 showed 50 percent more deaths than that same time period in 2019. Similarly, Milwaukee reported that in March and April of 2020, they have had a 54 percent increase in drug overdose calls compared to the same time frame in 2019.3 ODMAP has also reported that overdose clusters have moved from urban areas to suburban and rural areas.4 These large spikes in cases may be attributed to disrupted supply lines, social distancing measures, and the closing of many treatment and recovery centers.6
Top health officials warn that drug overdose is a rapidly growing issue that cannot be neglected during the pandemic.
Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) warned, “because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.” 5
Addiction Policy Forum’s Jessica Hulsey adds, “Our country must urgently remedy the decrease in access to treatment and support services during the pandemic. Expanded treatment options and more resources for those suffering from addiction are essential if we are to address the rise in overdoses and ensure those struggling with addiction have a safety net of support during the pandemic.”
By Rohith Kesaraju, Addiction Policy Forum Staff Writer
Addiction Policy Forum, May 2020, “COVID-19 Pandemic Impact on Patients, Families and Individuals in Recovery from Substance Use Disorder.”
Ahmad, FB, Rossen, LM, & Sutton, P. (2020). Provisional drug overdose death counts. National Center for Health Statistics.
Alter, A. & Yeager, C. (2020). “The Consequences of COVID-19 on the Overdose Epidemic: Overdoses Are Increasing.” Overdose Detection Mapping Application Program (ODMAP).
Alter, A. & Yeager, C. (2020). “COVID-19 Impact on the U.S. National Overdose Crisis.” Overdose Detection Mapping Application Program (ODMAP).
NIDA. 2020, July 7. COVID-19: Potential Implications for Individuals with Substance Use Disorders. Retrieved from https://www.drugabuse.gov/about-nida/noras-blog/2020/0 4/covid-19-potential-implications-individuals-substance-use-disorders on 2020, August 12
Wan, W. & Long, H. (2020). “'Cries for Help': Drug Overdoses Are Soaring during the Coronavirus Pandemic.” The Washington Post, WP Company, www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/.
Longley, J. (2020). “As Overdoses Spike During Coronavirus, Treating Addiction in Prisons and Jails Is a Matter of Life and Death.” American Civil Liberties Union. www.aclu.org/news/prisoners-rights/as-overdoses-spike-during-coronavirus-treating-addiction-in-prisons-and-jails-is-a-matter-of-life-and-death/.
Links to the Data:
According to a 2010 study, researchers found a strong link between those who witnessed, experienced, basically exposed to something traumatic in their childhoods and having an addiction or substance use disorder later in life. https://www.pinkvilla.com/lifestyle/people/addiction-factor-makes-us-4600-percent-more-prone-substance-abuse-552243 (Let's post something on aces, different source)
In the opioid crisis, young people face higher risks at every turn. They are often first exposed to opioids as teens and young adults, when they are especially prone to misuse and addiction. https://heal.nih.gov/news/stories/Youth-Opioid-Recovery (POST THIS)
There has never been a more critical time to provide medication for addiction treatment (MAT) for people with opioid use disorder (OUD). https://www.commondreams.org/views/2020/07/25/overdoses-spike-during-coronavirus-treating-addiction-prisons-and-jails-matter-life
CDC Data 2019 (My words)
There were 70,980 reported deaths due to drug overdose in 2019.
This number is likely underreported due to incomplete data, as there is a large delay in death certificate completion due to lengthy drug overdose investigations. The CDC predicted value is 71,999 deaths.
Of these reported deaths, 50,042 were due to opioids, with synthetic opioids (excluding methadone) accounting for 36,509 reported deaths.
This represents a 6.3% increase in deaths due to opioids.
There were 67,850 reported deaths due to drug overdose in 2018.
Of these reported deaths, 47,096 were due to opioids.
This is a reported 4.6% increase in 2019. This in contrast to the 4% decrease in 2018, the first decrease in 28 years (WAPO).
In 2019, next in line after opioids was psychostimulants with 16,279 deaths and cocaine with 15,974 deaths.
Previous year peak was 2017 with 70,699 reported deaths due to drug overdose.
Previous 12-month peak was November 2016-November 2017 with 70,723 reported deaths due to drug overdose.
33 states as well as New York City and the District of Columbia had a percent increase in deaths due to drug overdose from 2018 to 2019.
10 states had a less than 5% decrease in deaths due to drug overdose from 2018 to 2019.
South Dakota had the largest percent change, a 54.4% increase in deaths due to drug overdose between 2019 and 2018. North Dakota was next with a 28.6% increase followed by Alaska with 26.7% increase.
This data is still provisional but the percentage of 2019 deaths pending will only increase the total count to be larger than reported.
WAPO Article (Not my words)
Nationwide, federal and local officials are reporting alarming spikes in drug overdoses — a hidden epidemic within the coronavirus pandemic. Emerging evidence suggests that the continued isolation, economic devastation and disruptions to the drug trade in recent months are fueling the surge.
Data obtained by The Washington Post suggests that overdoses have not just increased since the pandemic began but are accelerating as it persists.
Suspected overdoses nationally — not all of them fatal — jumped 18 percent in March compared with last year, 29 percent in April and 42 percent in May, according to the Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals and police. In some jurisdictions, such as Milwaukee County, dispatch calls for overdoses have increased more than 50 percent.
Last year, the Cook County, Illinois medical examiner recorded 473 overdose deaths from January to June. This year, the total through May reached 656, with more than 400 additional suspected overdoses pending investigation and toxicology reports.
Nationwide, more than 20 million are unemployed as the nation faces its worst economic crisis since the Great Depression. Research has established strong links between stagnating economies and increases in suicides, drug use and overdoses.
As traditional supply lines are disrupted, people who use drugs appear to be seeking out new suppliers and substances they are less familiar with, increasing the risk of overdose and death. Synthetic drugs and less common substances are increasingly showing up in autopsies and toxicology reports, medical examiners say.
Social distancing has also sequestered people, leaving them to take drugs alone and making it less likely that someone else will be there to call 911 or to administer the lifesaving overdose antidote naloxone, also known as Narcan.
Making matters worse, many treatment centers, drug courts and recovery programs have been forced to close or significantly scale back during shutdowns. With plunging revenue for services and little financial relief from the government, some now teeter on the brink of financial collapse.
After March 19, 2020, 61.84 percent of participating counties experienced an increase in overdose submissions; There was a 17.59 percent increase in suspected overdose submissions when comparing the weeks prior to and following the commencement of state-mandated stay-at-home orders; Detected overdose clusters have shifted from traditional centralized, urban locations to adjacent and surrounding suburban and rural areas; and The number of spike alerts and the duration of overdose spikes have increased nationally.
There has never been a more critical time to provide medication for addiction treatment (MAT) for people with opioid use disorder (OUD). MAT consists of three FDA-approved medications—methadone, buprenorphine, and naltrexone—that treat OUD, the disease at the root of opioid addiction. MAT is basic healthcare and a cornerstone of care for tens of thousands of people in our communities who have OUD.
The need for MAT is particularly strong in jails and prisons: Without access to their medication, recently incarcerated people are left with few tools to battle their addiction. If provided with MAT, they are 74% less likely than people who are deprived of MAT to die of any cause while they are still incarcerated, and 85% less likely than people who are deprived of MAT to die of an overdose in the weeks after their release. Yet in the face of these stark numbers, 98% of jails and prisons still deny this lifesaving treatment to incarcerated people.
The small but growing number of prisons and jails that have implemented programs to provide MAT to incarcerated people with OUD have seen success. One study of the Rhode Island prison system, which was among the first to implement a robust MAT program, found that providing MAT reduced post-release deaths by 60%, and all opioid related deaths in the entire state by 12%. Sheriff Chris Donelan in Franklin County, Massachusetts reported a reduction in recidivism, overdose deaths, disciplinary concerns, and contraband after providing access to MAT.
As of July 22, more than 100,000 incarcerated people have been infected with Covid-19 and more than 760 have died. Even in the best of times, incarcerated people often receive substandard medical care, or no care at all. As Covid-19 cases make a resurgence in parts of the U.S. and continue to dramatically spike in jails, prisons, and detention facilities across the country, it has never been more important to provide evidence-based care for people with opioid use disorder in order to conserve hospital resources and save lives.
Further, as researchers have pointed out, the symptoms of opioid withdrawal and Covid-19 can overlap. Without access to MAT for OUD, there is an increased danger that prison officials will miss suspected cases of Covid-19, assuming that the symptoms exhibited are a result of opioid withdrawal, when in fact they are symptoms of Covid-19. This creates a danger that a positive Covid-19 case could be missed by a correctional facility, allowing a positive individual to spread the disease to others with whom they share close quarters. The answer to this problem should never be solitary confinement.
Denying incarcerated people access to MAT adds a strain on the American healthcare system, even in the best of times. Nearly one quarter of America's prison and jail population of 2.2 million have OUD. During this crisis, it is even more imperative that people with OUD get access to the MAT they need. Instead of letting unlawful and scientifically unsound jail policies fill our hospital beds with people experiencing post-release overdoses, let’s provide MAT to incarcerated people and use our hospitals to fight the Covid-19 crisis at hand.
If the numbers above indicate anything, it is that drug overdose is a rapidly growing issue that cannot be neglected during the pandemic, especially in justice settings. The justice system and lawmakers must urgently develop solutions to prevent fatal overdose and COVID-19 from disproportionately endangering the lives of the incarcerated.