Substance Use Rises as Isolation Takes Toll on People With Substance, Opioid Use Disorders During Pandemic

By Terri D’Arrigo

The COVID-19 pandemic has had a profound effect on the substance use crisis in the United States, spurring an increase in overdoses and overdose deaths. These deaths were accompanied by a sharp increase in substance use in the early months of the pandemic, most notably an increase in illicit fentanyl use, said Nora Volkow, M.D., director of the National Institute on Drug Abuse, in a presentation titled “Collision of the Opioid Crisis and the COVID-19 Pandemic” at APA’s online 2021 Annual Meeting.

“We are hearing from multiple organizations that fentanyl has dispersed across the country, and they are seeing it everywhere,” Volkow said. She reported that illicit fentanyl use rose 32% between March 13, 2020—the day COVID-19 was declared a national emergency and states implemented widespread stay-at-home orders—and May 2020. In the same period, methamphetamine use jumped nearly 20%, and cocaine use increased 10%. Overall, drug overdose deaths increased 42% in May 2020 compared with May 2019.

Volkow explained that people with substance use disorder (SUD) have a much greater risk of becoming infected with COVID-19. Opioid use disorder (OUD) confers the greatest risk: People with OUD have more than 10 times the odds of infection compared with people who do not have OUD. Those with any SUD have nearly 9 times the odds of infection as those without an SUD, those with alcohol use disorder have nearly 8 times the odds of infection, those with cocaine use disorder have more than 6 times the odds of infection, and those with cannabis use disorder have more than 5 times the odds of infection.

Volkow said the higher risk may reflect some of the physiological effects of substance use, which can compromise the respiratory and cardiovascular systems over time. The risk may also reflect the social and behavioral components of SUD, she said. For example, people with SUD often do not have access to appropriate care and treatment, and they may venture out into the community to obtain drugs, which increases their potential exposure to the virus.

The pandemic brought with it several challenges for people with OUD, particularly with respect to medication treatment, Volkow said.

“When patients go to a methadone clinic, they are put in very close [quarters]. It rapidly became evident that people were getting infected, … and it led to closing some of the clinics,” she explained.

Isolation has been particularly challenging for people with OUD, who have had limited access to peer-support groups and other sources of social connection, Volkow said.

“Social distancing exacerbated the isolation that people who have become addicted to opioids or other drugs already have, and that puts them at greater risk of relapse,” she said.

Volkow added that social distancing also increases the likelihood of overdoses when there is no one nearby who can administer naloxone.

“We are hearing reports from the communities that more people are dying from overdoses in their homes,” she said.

Volkow highlighted the ways the nation has sought to address pandemic-related challenges for people with SUD, including increased telemedicine, the establishment of mental health hotlines, and the release of nonviolent offenders with SUD from jails and prisons, where COVID-19 outbreaks rapidly spread. The Substance Abuse and Mental Health Services Administration now allows patients to take home a 28-day supply of methadone, allows a third party to take methadone to patients who are under quarantine, and allows door-step delivery of methadone for patients who are under quarantine. The Drug Enforcement Administration allows buprenorphine initiation through telehealth and follow-up for buprenorphine treatment via phone. ■