Epidemic in a Pandemic:
Flattening the Curve in the Opioid Crisis

June 2, 2020

By Patricia Strach, Elizabeth Pérez-Chiqués, and Katie Zuber

After more than a decade of increases, overdose deaths finally saw a decline in 2018. Yet, this positive trend appears to have come to an abrupt end in early 2020 as the United States faced COVID-19. Preliminary evidence suggests communities across the US experienced a spike in overdose deaths as economic uncertainty spread and social distancing impacted patients’ access to treatment.

According to one substance-use provider, flattening the curve for opioid overdose deaths “took millions and millions of dollars and a lot of innovative practices… it took a lot to reach that point and… we now have COVID.”

In fact, the providers we have spoken to so far express concern that the pandemic and shutdown will exacerbate problematic substance use. Increased levels of isolation, anxiety, and uncertainty will lead some people with existing substance-use disorders to turn to drugs and alcohol and may drive other people to engage in problematic use. Dwindling supplies of illicit drugs will encourage people to try new and potentially more harmful drugs. And social distancing will mean more people will be isolated when they use drugs, making it difficult to administer life-saving overdose reversal medications like Narcan.

At the same time, in response to the pandemic, federal and state agencies changed regulations about substance-use treatment. Notably, federal rules now allow patients to take home up to a 28-day dose of methadone and to receive mobile methadone (rather than going into a clinic). They allow providers to prescribe buprenorphine to new and continuing patients via telephone without requiring practitioners to first conduct an examination of the patient in person or via telemedicine. Regulations now allow telehealth visits for continuing patients on methadone. Yet, state-level social distancing requirements also apply to in-patient and out-patient services. These policies have implications for group and individual counseling and limit the number of patients that can be treated in any given facility.

Although we know that the pandemic may exacerbate problematic substance use and although regulatory changes may have an effect on access to treatment, we do not yet know what the effect of the pandemic or response to it has had.

In this series, we examine what has happened to substance-use treatment access and effectiveness during COVID-19. Our goal is to collect, analyze, and publicize data needed to make evidence-based policy moving forward. We start by establishing the baseline trends in opioid overdose deaths prior to COVID-19 and then provide insights from interviews we have conducted with people on the frontlines battling, what one provider described as, a pandemic on top of an epidemic.

Read the series…

The Facts Underlying America's First Decline in Overdose Mortality in 20 Years

This analysis examines the latest official data on overdose deaths from the CDC.

Overdose Mortality Demographics Data Dashboard

This data visualization shows the latest official data on overdose deaths from the CDC by geography, demography, and drug type.

A Therapeutic Approach to Substance-Use Disorder

This analysis details current practice and history of therapeutic treatment models for addressing opioid-use disorder.

The Impossible Task of Harm Reduction in Mexico During COVID-19’s Time

This analysis details extreme conditions for substance-dependent populations in Mexico created by lack of public funding for harm reduction organizations and economic and public health strains from COVID-19.

Substance-Use Services During COVID-19

This analysis examines the effects of three regulatory changes made in response to COVID-19 on the operations of substance-use service providers.

Stress, Fear, Anxiety, and Addiction During COVID-19

This analysis examines the stress, fear, and anxiety affecting those impacted by the opioid epidemic during the COVID-19 pandemic.

Podcast: Epidemic in a Pandemic

Clips from interviews with those on the frontline of the opioid epidemic and a discussion by the Stories from Sullivan researchers.

Webinar Takeaways: Epidemic in a Pandemic

This post highlights a few of the key observations by panelists on the webinar, including a birds-eye view of policy changes, on-the-ground experiences for different communities, and policy goals for the future.

Putting Children First

A look at how children and families experience the opioid epidemic, what happened to them during the pandemic, and the policies and programs that might best help them moving forward.

Lessons from Ohio

An interview with Dan Skinner, an associate professor of health policy at Ohio University’s College of Medicine, about the opioid crisis in Ohio during the COVID-19 pandemic.

Learning from Lived Experience

An interview with Nabarun Dasgupta, an epidemiologist at the University of North Carolina, about the importance of learning from lived experience and the improved research and policy that comes as a result.

NYS Substance-Use Disorder Services During COVID-19

This report examines what happened to New York State’s substance-use disorder services during the COVID-19 pandemic.

COVID-19 Doesn’t Respect Borders: A Conversation with Jaime Arredondo

This interview explores how COVID-19 affected drug use and treatment in Mexican cities along the USA-Mexico border.