People with substance use disorder face many obstacles to treatment. Federal legislative action of the opioid crisis, for instance, has been constantly ignored for years in the US. Unfortunately, things might get even more difficult with new public health precautions such as social distancing and self-quarantine to contain the rapid spread of COVID-19. These measures, while necessary to keep everyone safe and slow down the transmission rate of the virus, offer inconveniences to a person struggling with addiction.
Dr. Joseph Mega, the medical director of Contra Costa County’s Health Care for the Homeless program, is one of the many medical professionals that bring access to medication available for communities. Through the mobile street medicine team, they were able to hand out clean needles and Narcan, a medication that can reverse the effects of an opioid overdose, to people. Mega also prescribed one person buprenorphine, a medication that can block cravings, ease the agonizing pain of withdrawal, and make it easier for people to stop using opioids.
In a phone interview, Mega shared how he found a woman who had an infection under her skin from injecting into a muscle or using a needle that hadn’t been cleaned off. “And it looked pretty serious. This is an example of someone who had been delaying going to the hospital because they didn't want to be going there in the context of coronavirus,” he said.
Medical professionals like Mega are increasingly worried about people who are avoiding to seek vital medical services due to the concern about coronavirus. Many of the people he encounters are living alone in their homes. Thus, Mega worries that because of social distancing orders, people are also using drugs alone.
“Anytime someone is using alone that puts them at higher risk of overdose. If people are going to be injecting or using opioids, it's probably better for them to have a single other person around them than have no one, even in the context of the coronavirus pandemic. The risk of overdose from opioids doesn't go away,” he said.
The Opioid Epidemic
Every year, millions of people across the world use opioids to manage pain. This kind of drug acts in the nervous system to produce feelings of pleasure and pain relief. Some opioids are legally prescribed by healthcare providers to manage severe and chronic pain, including oxycodone, fentanyl, buprenorphine, methadone, oxymorphone, hydrocodone, codeine, and morphine. However, there are other opioids, such as heroin, that are illegal to use. With its capability to manage pain, it’s not surprising that people can get addicted to it.
In 2017 alone, healthcare providers across the US wrote more than 191 million prescriptions for opioid medication—a rate of 58.7 prescriptions per 100 people. Even when these drugs are prescribed appropriately and taken as directed, there’s still a high possibility that people can get addicted to it. According to the US National Library of Medicine, an online site that offers consumer-friendly information about human genetics, opioid addiction is characterized by a powerful, compulsive urge to use opioid drugs, even when they are no longer required medically. Reports revealed that more than 1,000 people are treated in emergency departments every day for misusing prescription opioids. Abuse of opioids not only leads to higher rates of addiction but also overdose deaths.
Almost 218,000 people in the US died from 1999 to 2017 from overdoses related to prescription opioids. In 2017, prescription opioids were involved in more than 35% of all opioid overdose deaths. A report from the Centers for Disease Control and Prevention (CDC) revealed that overdoses involving opioids killed nearly 47,000 people in 2018—32% of those deaths involved prescription opioids. An overdose occurs when high doses of opioids cause breathing to slow or stop, which can lead to unconsciousness and death if the overdose is not treated immediately.
Opioid addiction not only costs lives but also impacts our economy. CDC estimates that the total economic burden of prescription opioid misuse in the US is $78.5 billion a year. This includes the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.
Opioid Crisis Amid COVID-19 Pandemic
For millions of people suffering from opioid use disorder (OUD), COVID-19 brings several issues: methadone clinic shutdown, lack of face-to-face counseling services, and increased mortality risk from coronavirus from underlying respiratory damage. Due to several restrictions in many countries, traditional substance abuse recovery means such as face-to-face counseling and rehabilitation clinics are unavailable.
Methadone clinics, which have been established for the dispensing of methadone prescribed by doctors to mitigate opioid withdrawal and cravings that lead to relapse, can’t operate because they might violate social distancing guidelines. Experts fear that the pandemic might alienate people who use drugs from traditional news sources that can inform them about risks and best practices during a pandemic. This shows that while COVID-19 has a disproportionate impact on various vulnerable populations, people with drug addictions are facing unique challenges in response to the pandemic.
Many people relying on prescribed drugs to survive their daily lives have said that COVID-19 has made it harder to buy drugs. Daniel Ciccarone, a professor at the UCSF School of Medicine, said that as the supply of drugs goes down, overdoses go up because people will substitute drugs they’re less familiar with or change their habits. According to National Geographic, an American pay television network and flagship channel that is owned by National Geographic Partners, this makes dosing less reliable and potentially causes a spike in overdoses.
At the same time, the fear and uncertainty caused by the pandemic can aggravate anxiety and depression. This somehow encourages people to self-medicate with drugs and alcohol to ease the stress. Since not all drugs are available now, they will opt for any type of drug. As we continue to fight both opioid crisis and COVID-19 pandemic, experts say that we are likely to emerge from this pandemic with more new people suffering from addiction and more people who have fallen out of treatment and relapsed. Researchers are also gravely concerned that COVID-19 will increase already catastrophic opioid overdose rates given that infection epidemics disproportionately affect socially marginalized persons with medical and psychiatric comorbid conditions.
According to Annals of Internal Medicine, an academic medical journal, the pandemic is not only a threat to persons with OUD but also poses a serious risk that system-level gains in expanding access to medication for OUD, conducting critical research, and exacting legal reparations against opioid manufacturers will all be reversed.