By: Amanda G. S. Morgan
The opioid epidemic has become a large part of the lives of most Appalachians. If we haven't been affected directly by it, then we know someone who has been.
But now, with COVID-19, the opioid epidemic is poised to become an even bigger issue.
Supply chains have broken down, largely due to quarantines and border closings (United Nations Office on Drugs and Crime [UNODC], 2020, p. 1-6). While most would think that addicts would just be forced into withdrawal from such an event, it has only changed how opioid addicts get their "fix". Heroin shortages have been noted across the world, so other drugs may be used as replacements or additives. Fentanyl is commonly added to heroin to increase its potency, but with the shortages of heroin, fentanyl is a likely replacement (Kaur, 2020; UNODC, 2020, p.4). This, alone, could lead to overdoses.
Many people currently receiving treatment for substance use disorders have experienced significant changes to many of their support networks. While many patients who are compliant with their medication-assisted treatment therapies have been granted the ability to get increased days supplies of their prescription medications (Roy, 2020a; Roy 2020b), regularly scheduled face-to-face follow up appointments have largely been transitioned to telemedicine or online appointments. Support groups that were previously only accessible by meeting in-person have been forced to switch to online meetings (Kaur, 2020; National Institute on Drug Abuse [NIDA], 2020). Zoloft, an anti-depressant that is sometimes used as an adjunct therapy for substance use disorder treatment, has become a part of the FDA's drug shortages list since the start of the coronavirus pandemic (Berger, 2020).
These changes could lead to many people who are currently receiving treatment for various substance use disorders to turn to illicit substances again, especially if their access to their normal treatments is limited. The effects of this could range significantly, including recurring relapses, overdoses (including death), disease transmission, and more.
Many affected by opioid misuse are already in less-than-stable situations: homelessness, job loss, and stigma affect many people who suffer from substance use disorders.
Since many assistance programs are closed for services during the pandemic, drug users who participated in needle exchange programs may not have access to sterile needles. This may likely lead to an increase in bloodborne diseases, such as HIV and Hepatitis C (Kaur 2020).
Even without the increased risk for relapse, people who have used high dose opioids are at higher risk from COVID-19 simply from the negative effects that long-term high-dose opioid use can have on the lungs and heart. Opioid use also has the inherent risk of respiratory depression, as well, so a respiratory disease, such as the respiratory effects of COVID-19, could cause low to no oxygenation of the brain. The effects could range from brain damage to death (NIDA, 2020).
Many cities across the United States have reported overdose rates that may be increasing as the coronavirus lockdowns continue. Many harm reduction services, such as needle exchange and naloxone distribution programs, have had to shut down due to the coronavirus pandemic (Kaur, 2020).
Not enough data is available yet to conclude if the COVID-19 outbreak and resulting shutdowns have or will cause an increase in opioid overdoses. But we do know that many people may not have access to their support networks. They may not have access to many of the programs that are available to help mitigate risks, such as bloodborne pathogens from needle sharing or group therapy and support sessions. They may not have access to the substances they normally abuse and have turned to other illicit substances that may be more potent or otherwise less safe (Kaur, 2020).
During these times, if you know someone who suffers from substance use disorder, it is crucial to check on them. Social contact certainly will help them feel less isolated, even if it is just a phone call or a video chat. Checking in on them could also help, especially if they live alone. If someone who lives alone overdoses, they won’t be able to administer life-saving naloxone to themselves if they overdose (NIDA, 2020; Roy, 2020b).
While the coronavirus pandemic is certainly quite troubling in and of itself, the fallout from it could certainly have far-reaching effects. Some of our already vulnerable populations, including those suffering from opioid use disorder, could see even more effects than many people realize. Because someone prone to opioid abuse does not have access to their support systems, normal treatments, or drug of choice, they may become desperate and resort to other means to get their fix.
If you or a loved one need help in locating resources to help with opioid addiction, please contact the SAMHSA National Helpline at 1-800-662-HELP (4357).
Berger, M. (2020, June 4). Shortages of Antidepressant Zoloft Reported in the Midst of COVID-19. New York, NY: Healthline: Health News. https://www.healthline.com/health-news/shortages-of-antidepressant-zoloft-reported-in-the-midst-of-covid-19-pandemic
Kaur, H. (2020, May 7). The opioid epidemic was already a national crisis. Covid-19 could be making things worse. Atlanta, GA: CNN: Health. https://www.cnn.com/2020/05/07/health/opioid-epidemic-covid19-pandemic-trnd/index.html
National Institute on Drug Abuse. (2020, June 29). COVID-19 Resources. Bethesda, MD: National Institute on Drug Abuse: Drug Topics: Comorbidity. https://www.drugabuse.gov/drug-topics/comorbidity/covid-19-resources
Roy, L. (2020, April 21). Treating Substance Use Disorders in the Era of COVID-19. New York, NY: Psychology Today: Substance Use, Stigma, and Society. https://www.psychologytoday.com/us/blog/substance-use-stigma-and-society/202004/treating-substance-use-disorders-in-the-era-covid-19
Roy, L. (2020, May 28). Collision Of Crises: How Covid-19 Will Propel Drug Overdose From Bad To Worse. Jersey City, NJ: Forbes: Healthcare. https://www.forbes.com/sites/lipiroy/2020/05/23/collision-of-crises-how-covid-19-will-propel-drug-overdose-from-bad-to-worse/
United Nations Office on Drugs and Crime. (2020, May 7). COVID-19 and the Drug Supply Chain: From Production and Trafficking to Use. Vienna, Austria: United Nations: Office on Drugs and Crime. Retrieved July 6, 2020 from: https://www.unodc.org/documents/data-and-analysis/covid/Covid-19-and-drug-supply-chain-Mai2020.pdf.
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