Research produced in 2020 has shown a disturbing link between substance abuse and COVID-19.
Millions of people living with mental health and substance use disorders (SUDs) in the United States have been urged to socially-distance and isolate in the last year to prevent the spread of the deadly coronavirus, also known as COVID-19.
Since the pandemic began, nearly half a million people in the United States have died due to the coronavirus.
And with new, infectious variants of the virus gaining traction in populous states like Florida and California, the triaging of available vaccines is currently unable to quell the life-threatening surges in positive cases across the country.
Meanwhile, a second public health crisis has also emerged during the pandemic year: namely, a surge in drug overdose deaths. Late last year, the Centers for Disease Control and Prevention (CDC) reported a concerning jump in drug overdose deaths from 67,367 deaths in 2018 to 70,630 overdose deaths in 2019—nearly a five percent increase.
Although completed data for 2020 won’t be available until sometime this year, a separate health alert from the CDC shared warnings of an acceleration in drug overdose deaths in 2020, which could put it on track to become the deadliest year for drug overdose deaths in the U.S. in recorded history.
The COVID-19 pandemic has forced the nation’s medical and behavioral healthcare systems to reckon with the implications that self-isolation, restricted mobility, and limited access to in-person treatment could have on the millions of people in the United States who struggle with some form of substance abuse problem.
Understanding the impact of COVID-19 on substance abuse is half the battle. For those who struggle with substance abuse, or know someone who does, here are ten ways in which the COVID-19 pandemic is already affecting substance use in America:
1. Increased Overdose Rates
The most devastating effect the pandemic has had on populations who struggle with drug or alcohol abuse is what the CDC reports as “substantial increases” in drug overdose deaths.
According to the CDC, an estimated 81,230 drug overdose deaths occurred between June 2019 to May 2020, with noted increases in overdose deaths involving synthetic opioids (excluding methadone) and stimulants like cocaine and methamphetamine (meth).
Overdose is a life-threatening reaction that can occur when someone has either taken too much of one or more drugs (including alcohol), leading to adverse effects throughout the body, including slowed or stopped breathing, irregular heartbeat, and coma.
If you’re reading this, one question you may be asking, however, is: What caused the surge?
Public health experts have pointed towards several potential factors, including:
- Rising rates of unemployment
- Financial precarity
- Increased interpersonal conflict.
2. Illicit Drug Supply and Access
Many of the drugs most commonly misused by people in the United States, including illicit drugs like heroin and cocaine, are trafficked into the U.S. through the US-Mexico border and by air and sea.
As a consequence of border shutdowns, intended to prevent the spread of the coronavirus, this has disrupted the distribution network of some of these drugs.
According to the United Nations Office on Drugs and Crime (UNODC), the COVID-19 pandemic has “inevitably affected” all aspects of illegal drug markets, although the extent of the impact varies by drug.
And contrary to one might expect, reduced access to addictive drugs is not necessarily a positive. As seen with a shift from prescription opioid abuse to heroin abuse following crackdowns on opioid prescribing, people who are addicted to drugs may go to dangerous lengths to find substances to stave off withdrawal symptoms or to otherwise continue using.
This carries a high risk for drug overdose and using drugs that are contaminated with toxic chemicals and drugs like fentanyl, which—when illicitly manufactured—can be deadly in small doses.
3. Drug Prices
Inevitably, as the supply chain is disrupted, so too are the prices for commonly used street drugs. Changes in the average cost of drugs during the pandemic has varied by type of drug, location, and drug source.
Last year, the UNODC shared that most drug-producing countries reported decreased prices, influenced by factors including stockpiling, oversupply, and difficulty trafficking drugs abroad.
However, there were also reported increases in drug prices in countries with drug shortages, including the United States.
This comes in part because of mobility restrictions, and applies to some pharmaceutical drugs like benzodiazepines (e.g. Xanax) and buprenorphine (Subutex, Suboxone). Drug companies like Pfizer, Novartis, and Sanofi have also been reported as quietly raising prices of some of their drugs during the pandemic.
4. Greater Stress
Many people have felt scared, worried, and anxious about the state of the world over the past year. A recent news release from the Kaiser Family Foundation shared that 1 in 4 adults in the United States have reported symptoms of anxiety or depressive disorder during the pandemic. This is up from 1 in 10 adults who reported these symptoms from January to June 2019.
The same report shared that young adults, which have the highest reported rates of SUDs in the United States, were nearly twice as likely to report substance use during the pandemic.
Common causes of pandemic-related stress include stress related to employment, insufficient childcare, school closures, low income, and insufficient access to mental healthcare—which disproportionately burdens poor communities of color.
Stress in general is widely known to be a risk factor for heavy drinking, drug use, and other maladaptive coping mechanisms. It’s common for people to report drinking or drug use as a way to “take the edge off,” so to speak.
Unfortunately, for some, using drugs for this reason can become a compulsive crutch that, over time, can become debilitating to physical health, mental health, and general way of life.
5. Myths About COVID-19 Cures
Over the course of the pandemic, several theories have emerged with false claims that cocaine use can “cure” or reduce one’s susceptibility to contracting the coronavirus.
“Under no circumstances should people use any type of substances as a means of preventing or treating COVID-19 infection,” writes the World Health Organization (WHO), “Substance use will not protect from COVID-19.”
6. High Risk For COVID-19
People with substance use disorders have been identified as a population within the high risk category for catching and developing severe symptoms of the coronavirus, due to psychological, clinical, economic, and social conditions.
Many people who have substance abuse issues, for one, also have co-occurring cardiovascular and respiratory diseases associated with severe COVID-19 complications.
Sharing drug paraphernalia—including needles and syringes—or generally being in proximity to others in shelters or settings for drug use is also linked to a greater risk for COVID-19 spread.
7. Access to Healthcare
Insufficient health insurance is a major barrier to mental health and substance abuse treatment. In 2019, the Kaiser Family Foundation reported an estimated one-fifth, or 18 percent, of non-elderly adults with opioid use disorder (OUD) were uninsured.
In the United States, about 50 percent of Americans get insurance through their employer—a percentage that has had devastating consequences for the millions of people who have reported unemployment over the course of the pandemic.
While the federal and state governments have scrambled to expand affordable access to treatment before and during the pandemic, the fact remains that life-saving addiction treatment services are overwhelmingly inaccessible to people who lack health insurance or live in treatment deserts, where free and low-cost services may be scarce.
Early on in the pandemic, many medical and behavioral health treatment providers shifted or expanded their services to include treatment that could be provided over video or over the phone, also known as tele-health or telemedicine.
For some, this has actually made it easier to obtain treatment services including behavioral therapy, medical consultations, and medication-assisted treatment due to the flexibility and insufficient transportation necessary.
Unfortunately, tele-health services are not covered by all health insurance providers.
In addition, insufficient access to Wi-Fi service or telephone service can also be a barrier for people who lack the necessary technological requirements to receive tele-health services from providers.
9. Opioid Use Disorder Treatment
Prior to the pandemic, many people addicted to opioids, including illicit opioids like heroin, would visit rehab clinics on a regular basis to receive medications for opioid use disorder (MOUD) like methadone.
During the pandemic, federal health agencies have at least temporarily changed some regulatory processes governing providers’ options for distributing these medications.
For instance, more people are now able to receive buprenorphine therapy, also known as Suboxone, through telemedicine. Prescribers are also able to provide larger take-home supplies of methadone, to subvert long and crowded waiting lines in methadone clinics.
These changes are critically important. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), medications for OUD, along with behavioral therapy, reduces the risk of relapse, overdose, and increases treatment retention.
The effects of these changes—positive and negative alike—are an ongoing area of study as treatment providers consider the implications of what promising results from these innovative strategies could bring.
10. Social Support and Isolation
Avoiding in-person social interaction has been a necessary, but cutting decision during the pandemic. While state regulations on in-person gatherings have varied significantly, it’s often remained up to individuals to decide how and when to travel, meet, and see others.
One of the most important aspects of addiction recovery services, like 12-Step programs and other support groups like SMART Reecovery, is the social aspect. Addiction is a lonely, isolating condition.
Often, a hallmark feature of addiction recovery is reconnecting with other people and healing relationships hurt by substance use and its consequences. Furthermore, being isolated can also trigger urges to use among people with a history of substance use.
Social isolation, loneliness, and boredom are known to increase the risk of relapse in people with a history of harmful substance use. Isolation may also cause people to use drugs alone, which can mean having no one around to call 911 in the event of an overdose.
Substance Abuse and COVID-19: Where We Go From Here
As we consider the effects the COVID-19 pandemic has already had on substance use and people with substance use disorders, the extent of the impact is yet to be seen.
Yet, one can be assured researchers within the fields of public health, behavioral health, and psychiatry will be following this closely, and—for better or for worse—will have more information to share in the months to come.
For those who are struggling with substance abuse, or have a loved one who is struggling, there are numerous COVID-19 and mental health resources publicly available online.
You are not alone.
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