More than 83,000 drug overdose deaths occurred during the 12 months ending in May 2020, the most ever recorded during a one-year period, according to the Centers for Disease Control and Prevention. Scientists think the COVID-19 pandemic has accelerated an already alarming trend in overdose fatalities.
Overdose deaths in the United States have surged during the COVID-19 pandemic, primarily driven by increased fatalities from synthetic opioids and illegally manufactured fentanyl, according to a report issued in December 2020 by the Centers for Disease Control and Prevention (CDC).
Fatalities tied to synthetic opioids and illegal fentanyl climbed 38.4 percent in the 12 months ending in May 2020, compared with the same period ending in May 2019, according to the CDC. The spike in overdose deaths tied to these substances was even steeper in several parts of the country, almost doubling in 10 Western states.
In addition, overdose deaths involving psychostimulants such as methamphetamine increased by 34.8 percent, exceeding the total number of fatalities involving cocaine. Overdose deaths from cocaine climbed 26.5 percent, likely due to combined use with illegally manufactured fentanyl or heroin, the CDC reports.
There are likely several reasons why drug overdose deaths have surged since the onset of the COVID-19 pandemic, says Alana Vivolo-Kantor, PhD, lead health scientist at the division of overdose prevention at the CDC in Atlanta. These include a larger supply of illegal drugs, reduced access to addiction and overdose treatment, and the lethality of synthetic fentanyl.
“Limited access to and disruption in treatment for patients who use drugs or with substance use disorder can be very stressful,” Dr. Vivolo-Kantor says. “There is a concern that these disruptions can lead to increased use or return to drug use for people not currently using.”
How the Pandemic Can Make Addiction Worse
“The unprecedented social isolation, coupled with unemployment and financial distress, are likely important factors increasing risks for patients,” says Dr. Kilaru, who wasn’t involved in the CDC report. “For patients with substance use disorders, overdoses that occur while alone are more likely to result in death.”
A study published in December 2020 in the Journal of Urban Health, for example, found that there was a 47 percent surge in overdose deaths following a stay-at-home order in Indianapolis. In this community, calls to emergency medical services (EMS) climbed 4 percent overall after the stay-at-home order while EMS calls for overdoses increased 43 percent.
Opioid overdoses are also more common among people who are unemployed, living alone, or living in poverty — all situations that have become more common during the pandemic. A study published in January 2020 in PLoS One, for example, found that people without jobs or spouses were more than twice as likely to die from opioid overdoses as those who were married and employed.
The growing number of overdoses involving synthetic fentanyl is also making matters worse because this substance makes people more likely to die when they overdose, Kilaru says. People who misuse drugs might seek out fentanyl without realizing this, use a more potent and potentially lethal dose of fentanyl than they expected, or take opioids or stimulants they don’t know are laced with fentanyl.
“Illicitly manufactured fentanyl is extremely lethal regardless if it’s used alone or mixed with other drugs,” says Vivolo-Kantor.
Part of the reason fentanyl makes overdoses more dangerous is that Narcan (naloxone), a drug that saves lives by inhibiting the breathing suppression caused by opioids, doesn’t work as well against fentanyl, Vivolo-Kantor says.
“This increases the likelihood that overdoses will be fatal even when people get prompt treatment,” Vivolo-Kantor says. “We also know that it may take several doses of naloxone to reverse its [fentanyl’s] effects.”
Opioid Addiction Treatment During the Pandemic
Pandemic shutdowns that have reduced access to care for so many health issues have also curtailed access to treatment for drug addiction. And even though telehealth visits have been used during the pandemic, there are unique barriers to this care that have complicated efforts to help people with opioid use disorder, says Stefan Kertesz, MD, of the University of Alabama at Birmingham and the Birmingham Veterans Affairs Medical Center.
Federal, state, and local governments have restrictions in place that limit who can prescribe medications for opioid use disorder, where patients can get these treatments, how much medicine patients can get at once, and what lab tests or clinic visits may be required for refills.
Some restrictions were loosened during the pandemic. The federal Substance Abuse and Mental Health Services Administration eased rules requiring daily clinic visits for the anti-addiction drug methadone, instead allowing some to get a 28-day or 14-day supply at once. And the federal Drug Enforcement Administration changed prescription rules for the anti-addiction drug buprenorphine to allow telehealth visits for doctors to prescribe the drug and permit refills without requiring patients to first get a drug test.
While changes like this have made it possible for some patients to access treatment who might have otherwise been cut off during the pandemic, many individuals with substance use disorder may still lack access to care because they don’t have internet, or a mobile phone or computer, to use telehealth services, says Dr. Kertesz.
“A lot of folks in dire straits do not have great data plans and smartphones,” Kertesz says.
At the onset of the pandemic, only about 1 in 4 substance use treatment facilities in the United States had the capacity to offer telehealth services, according to a study published in December 2020 in the Journal of Addiction Medicine.
Even within the Veterans Health Administration, through which telehealth services have long been an option for a wide variety of care, this option isn’t always accessed by vulnerable patients and individuals with substance use disorder, according to a separate study published in December 2020 in the Journal of Addiction Medicine. This study focused on veterans with a history of homelessness, and it found that, among those with various types of addiction, use of a web-based portal for care was much lower among patients with opioid use disorder.
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