Effects of Covid-19 on the Opioid Crisis

It is easy to forget in the midst of the Covid-19 pandemic that the United States was already experiencing another major public health crisis: the opioid epidemic.  This epidemic affected millions of Americans and caused the deaths of more than 47,600 people in the U.S in 2018. Although there were signs that the opioid crisis was subsiding prior to the Covid-19 pandemic, the opioid crisis has re-intensified due to social isolation, stress and financial insecurity.

A Closer Look at the Opioid Crisis

In order to understand why the opioid crisis has occurred, you must first understand what an opioid is. Opioids are a class of drugs that act on the opioid receptors in the brain. These drugs include illicit substances as well as prescription medications like

  • Heroin
  • Oxycodone
  • Codeine
  • Morphine
  • Fentanyl

Once an opioid substance interacts with an opioid receptor on a nerve cell in the brain, it blocks pain and elevates mood. This pleasure response produces a feedback loop in which you try to reproduce the euphoria. Ultimately, this causes opioid dependency by re-wiring the brain.

This pattern of behavior is why almost 10.3 million Americans abused opioids in 2018 and an estimated 2 million had an opioid use disorder. Opioid dependency has caused more than 130 deaths a day in this country.

However, it should be noted that there was a 4 percent decline in opioid overdose deaths from 2017 to 2018. This includes a 13.5 percent decline in prescription opioid-related deaths year over year. This is at least partially due to fewer prescriptions being handed out by physicians.

How Covid-19 Is Making Things Worse

What progress had been made in combatting the opioid scourge has since been obviated by the pandemic. The unfortunate combination of lockdown, financial insecurity and stress has not only made it difficult for recovering addicts to sustain sobriety, but it has also pushed others into substance abuse.

One study published in JAMA, found that in 150,000 urine samples from 2019 and mid-year 2020 found an increase in the presence of fentanyl, methamphetamine, cocaine and heroin. Although this was likely not a randomized sample population, it does indicate that there is likely increased use of illicit substances.

One of the key issues driving this surge is emotional deterioration.  A survey by the Centers for Disease Control and Prevention conducted this past summer found that out of 5,000 people, almost 40 percent were struggling with anxiety, depression, or post-traumatic stress. Additionally, more than 10 percent of survey respondents admitted to having suicidal thoughts, suggesting there is considerable emotional unwellness that is going untreated since the onset of the pandemic.

What can’t be underestimated is the ongoing stress of the pandemic.  In addition to the emotional burden of living in isolation and diminished income is the psychological strain due to a potentially fatal illness. This is also exacerbated by having to work in a workplace significantly altered by Covid-19 including more solo projects, diminished socializing, and rigid safety protocols. Those who work from home must combine work with family responsibilities which is very stressful.

This poor emotional health in the general population has been exacerbated by a lockdown that has restricted access to health care. Although new ways of extending health care via telephone and video have burgeoned during the pandemic, many patients and health care providers feel that many health care issues including substance abuse and mental health are falling through the cracks.

Most notably, the lockdown has stifled use of treatment for opioid use disorder. One study of a single emergency department from March-June 2019 and March-June 2020 found that the number of opioid overdoses grew from 102 in 2019 to 227 in 2020. Of those who survived such overdoses, only 10 percent attended addiction treatment. Once again, this is a skewed sample size, but there is a likelihood that other ERs around the country are experiencing similar surges.

Even those who want to go to treatment may find it difficult.  With so many job losses, fewer people have the resources to seek treatment. The spread of Covid-19 has shut down many addiction treatment facilities and limited availability of treatment drugs like methadone and naloxone.

How to Avoid an Opioid Use Disorder During a Pandemic

It can be difficult to get help for an opioid use disorder during the Covid-19 pandemic, but it isn’t impossible. If you find yourself in need of medical or psychological assistance, you may want to try some of these options.

  • Virtual naloxone training—many public health agencies are now offering online courses in naloxone use. This can help you or a loved one recognize the signs of an opioid overdose and take the appropriate steps to head off a fatal incident.
  • Safe drug disposal—if you or someone you live with is at risk of opioid abuse, then you should dispose of any unused medications that could be misused. You can take them to any pharmacy or to a drug take-back site.
  • Join a treatment program—even in the midst of a pandemic, there are still treatment programs available.  Look for programs that use medications like methadone or buprenorphine to ease withdrawal symptoms and reduce cravings.
  • Emotional support—if you live with family or friends, then maintain open lines of communication.  Be open with your struggles, and you will find it much easier to maintain your sobriety. If you live alone, take the initiative with friends or online support groups.
  • Talk to your doctor—more physicians are making themselves available to their patients via phone or video during the pandemic. Physicians can now prescribe medications like methadone or buprenorphine for up to 28 days, so this can limit the need to venture out.
  • Equipment stockpile—although it may sound counter-intuitive, if you are going to use heroin or other opioids via smoke or injection, stock up on clean needles and other supplies. You can transmit Covid-19 by sharing needles, and inhaling controlled substances can weaken your lungs and make you more vulnerable to infection.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

M.D. Disclaimer: The views expressed in this article are the personal views of Robert Moghim, M.D. and do not necessarily represent and are not intended to represent the views of the company or its employees.  The information contained in this article does not constitute medical advice, nor does reading or accessing this information create a patient-provider relationship.  Comments that you post will be shared with all visitors to this page. The comment feature is not governed by HIPAA and you should not post any of your private health information.