The last two years had brought small but significant victories to the nation’s opioid crisis, with slow, steady declines in opioid use and deaths marking a positive change to this major public health problem.
That was until the COVID-19 pandemic hit, bringing months of an uncertain and unsettling new normal to people around the world.
As the pandemic continues to stretch on with no clear end in sight, the U.S. rates of anxiety, depression and drug use are all on the upswing.
“Tighter drug monitoring, recovery programs and medical treatments were all making a difference,” said HSC Regents Professor Scott Walters, PhD, who serves as Steering Committee Chair for the HEALing Communities Study, an aggressive, National Institutes of Health (NIH) trans-agency effort to speed scientific solutions to the national opioid public health crisis.
Other factors had also been helping.
Many states began to make naloxone, a rapid-acting overdose antidote, accessible to the public through pharmacies or by mail without the need for a prescription. Some states also began distributing this lifesaving medication to people at risk for overdose, such as those being discharged from jail or prison.
“These changes have greatly helped people who are trying to quit, or to stay clean, achieve more successful outcomes,” Dr. Walters said.
But now, there is worry that these gains are being lost due to the anxieties, stresses and negative mental health consequences of COVID-19.
In an August 2020 report, the CDC estimated that as many as 40% of U.S. adults have struggled with mental health or substance use during the pandemic. The study, which looked at a one-week sample period in June, found that 31% of participants had suffered with anxiety and symptoms of depression; 26% had trauma or stress-related symptoms; 11% had seriously considered suicide; and 13% had started or increased substance use.
“The pandemic has really complicated our efforts to address these problems,” Dr. Walters said.
In July, the New York Times reported that drug deaths for 2020 had risen an average of 13% over last year, with warnings that, “If this trend continues for the rest of the year, it will be the sharpest increase in annual drug deaths since 2016, when a class of synthetic opioids known as fentanyls first made significant inroads in the country’s illicit drug supply.”
“Supply and demand in the illicit drug industry was impacted early on by COVID-19,” Dr. Walters said. “Some states initially experienced decreases in drug use because supply chains were pinched – chemicals were harder to get, shipping was slowed, and people couldn’t produce or deliver the product – in this case, illegal drugs.”
“But then it came back with a vengeance. Homegrown, locally-manufactured drug supply took over.”
With drugs like fentanyl, where even the slightest changes in chemical compounds or dosing can mean the difference between intoxication and death, the results can be tragic.
Users who are unable to get illicit drugs because of supply chain slowdown, Dr. Walters noted, will also have lower tolerance when reintroduced to drugs, which could put them at serious risk for overdose, even if they are using their usual amount.
Treatment services and recovery groups have also suffered disruptions during pandemic closings and social distancing, leaving users in a perilous place for support.
“Most of these services are online now,” Dr. Walters said. “It’s more challenging to connect with a provider, especially for treatment programs requiring an initial in-person assessment or follow up, as with methadone programs. Many of the usual safety networks are operating differently now.”
“Other likely contributors to the increase are people having more time on their hands without much to do, social isolation, substances being used to cope with the anxieties of COVID life, employment concerns, loneliness, fear, personal or family issues,” he added.
With Texas overdose rates mirroring other states around the U.S., at about 18% higher for the first six months of 2020 compared to 2019, the big question is, where do we go from here?
“Federal guidance waiving in-person requirements for drug disorder visits will continue to be important, as will the programs that have already started to support at-risk populations,” Dr. Walters said.
“Most people who start using opiates get them from someone’s medicine cabinet, so securing prescription medicines at home, using socially-distanced drop off programs in your community to get rid of old medications, or even flushing medicines on the FDA’s approved list might make the difference in saving a life,” he said.
When community take-back options are not available or impacted by a crisis like COVID-19, the U.S. Food and Drug Administration offers a listing of specific drugs that may be flushed, including fentanyl and oxycodone.
“Responding to this public health threat is even more critical right now,” Dr. Walters emphasized, “as communities struggle with the realities of COVID-19’s impact on mental stress and substance use. The actions we take now will affect today’s outlook as well as tomorrow’s.”