The first wave of the COVID-19 pandemic in the United States sickened over 1.9 million people and took the lives of more than 100,000. The virus caused far-reaching consequences as it swept through communities across the country. Governors issued stay-at-home orders, businesses closed down, and millions of people lost their jobs. The virus also took the focus away from existing public health crises like the opioid epidemic. Now, new evidence shows that opioid overdose deaths have spiked during the COVID-19 pandemic.
The Link Between COVID-19 and Opioid Abuse
At first glance, it may not seem like a respiratory virus and drug addiction have much in common. But further analysis shows that the COVID-19 pandemic and opioid abuse are strongly intertwined.
First, both opioids and coronavirus affect the respiratory system. When a person uses opioids, the drug travels through the body and binds to opioid receptors. Opioids are considered a central nervous system depressant, meaning they slow nervous system activity. This causes the heart rate to slow, pupils to dilate, and breathing to become slower and shallower. In fact, most overdose deaths occur because breathing stops altogether. Coronavirus also affects the respiratory system. It causes shortness of breath, labored breathing, and flu-like symptoms. People who chronically use opioids are at increased risk for COVID-19 complications. Their lungs are simply not able to handle the virus as well as non-opioid users.
Second, the COVID-19 pandemic caused a rapid mobilization of public health resources to protect and treat people affected by the virus. Some of this came at the expense of existing resources to fight the opioid crisis. Some medication-assisted detox programs temporarily shut down, people missed regular clinic visits due to social distancing measures, and state departments of health-focused their efforts on COVID-19. This left many people feeling shut out at a time when they were most vulnerable to relapse. Plus, the sudden drop in opioid supply caused some people to change dealers or use different, more potent drugs than usual.
Third, and perhaps most important, COVID-19 has caused major mental health problems for millions of Americans. More than 40 million U.S. adults have an anxiety disorder, and 16.1 million have depression, according to the Anxiety and Depression Association of America. The coronavirus pandemic has worsened these conditions. People are stuck at home, unable to visit friends or family. Simple trips to the grocery store feel scary due to the potential for sickness. Many people have lost their jobs or were furloughed. For those who are continuing to work, many are juggling work while watching children who have been sent home from school or daycare.
The massive stress of the pandemic has exacerbated depression and anxiety symptoms for many people. It has also made it more difficult to get mental health treatment. Instead, people often turn to unhealthy coping techniques to deal with their symptoms. Using opioids can temporarily numb emotional pain, but it doesn’t help the underlying mental health problem. This combination of higher mental health symptoms and less support means that more people than ever are turning to drugs to feel better.
Rising Opioid Overdose Deaths During the COVID-19 Pandemic
Given the links between COVID-19 and opioid abuse, it is no surprise that overdose rates have begun to rise. But the degree of the rise has alarmed some experts. Recent data from the Overdose Data Mapping Application Program, a national surveillance program, showed a 16.6% increase in suspected overdoses compared to the same time last year. Fatal overdoses rose nearly 11.4%, while non-fatal overdoses rose 18.6 percent.
It will take several weeks to obtain precise figures about the changing opioid overdose rate in specific geographic regions. So far, though, there are worrying signs from several vulnerable communities. Virginia Governor Ralph Northam said that Roanoke County had twice as many fatal overdoses from January through May 2020 as they did for all of 2019. Milwaukee reported 155 confirmed overdoses so far in 2020, compared to 158 totals for all of 2019. Franklin County, Ohio, has 50% more deaths compared to the same time last year. Erie County, New York, which includes Buffalo, had nearly double the usual number of deaths. All across the country, the numbers are clear: the COVID-19 pandemic corresponds with a dramatic increase in opioid-related overdose deaths. As medical examiner’s offices make their way through a backlog of toxicology tests, these numbers may continue to rise.
The increase in opioid overdoses is particularly disappointing, given that it appeared that the tide had begun to turn last year. In January 2020, the CDC reported that the drug overdose death rate dropped 4.6% compared to 2017, which had the highest number of deaths on record. Experts were hopeful that additional progress would be made in 2020. Now, a scientific report predicts additional deaths from drugs, alcohol, and suicide could range from 27,644 to 154,037 over the next decade. Public health officials call these “deaths of despair,” given their link with mental health problems, economic devastation, and chronic pain.
People in recovery are especially vulnerable to opioid overdose. As the body recovers from opioid dependence, opioid receptors change in their sensitivity to the drug. When someone who has been abstinent from opioids starts using again in a time of crisis, they often return to their usual dose. However, they no longer have the same tolerance built up. Using the same dose can overwhelm their body with opioids and cause an unintentional overdose. Overdoses may also be more common because of disruptions to the global opioid supply. With many people cut off from their usual dealers, they may not be familiar with the drugs or doses they buy. Dealers often lace drugs with fentanyl, sometimes without a person’s knowledge. This can significantly increase the potency of the drug, causing unintentional overdoses.
Expanding Treatment Resources for Opioid Abuse
We are in a perfect storm of problems: a decades-long opioid epidemic, the COVID-19 pandemic causing deep mental health pain, an economic downturn, and isolation from friends and family at the time they are most needed. There is no simple solution to get out of this situation. But without action now, we will be paying the price for years to come. Even after the COVID-19 pandemic is over, we may be left with millions of people addicted to drugs, and thousands of deaths that could have been prevented.
Mental health treatment is a critical piece of the puzzle. People with untreated mental health problems are significantly more likely to start using drugs and keep using them. Opioids and other drugs provide a temporary bandage for emotional pain, but they do not work long term. To overcome opioid addiction, new coping strategies are needed.
The first step is for people affected by opioid abuse to get evidence-based treatment. Medically-assisted detoxification programs help to clear opioids from the body. Undergoing detox in a safe, humane, compassionate environment sets the trajectory for the rest of a person’s recovery. Following medical detox, the person can begin to adjust physically and mentally to a life without opioids. This includes doing the hard work of addressing underlying problems that fuel opioid addiction. Aftercare programs must generally include mental health treatment to work on anxiety, depression, trauma, and other root causes of addiction. Only by taking this comprehensive approach to addiction treatment will people begin to heal.
Opioid addiction is just one symptom of a larger problem in our society: despair. For too long, people have been cut off from the programs and resources that could help them thrive. They are left to suffer emotional pain that is not easily relieved.
COVID-19 pandemic didn’t create despair, but it made it even worse. This is an opportunity for our country’s leaders to take action. By shining the light on the opioid crisis, they can expand treatment resources, improve mental health, and prevent unnecessary deaths from a drug overdose.