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.