Now, the coronavirus has disrupted all matters of life across the country — including efforts to combat the nation’s opioid problem.
Walk-in clinics and syringe exchange programs have been closed. Community support groups are meeting virtually.
Some who struggle with substance abuse are homeless or incarcerated and can’t comply with social distancing guidelines, while those who can are left isolated and at risk. On top of all that, the pandemic is causing massive stress — a primary driver of relapse.
“This changing, very strange world that we’re living through could serve as a trigger for people to return to drug use,” said Daliah Heller, director of drug use initiatives at the public health organization Vital Strategies. “And that brings a great potential for overdose with it.”
As local officials report spikes in overdose calls and deaths, experts and advocates say they’re concerned the coronavirus pandemic is making an already serious problem worse.
Local officials are reporting overdose spikes
County coroners, law enforcement and emergency responders around the country are reporting spikes in overdose calls and deaths — and they’re concerned that’s connected to Covid-19.
It’s too soon to determine whether such reports are evidence of a larger trend, said Nora Volkow, director of the National Institute on Drug Abuse.
Federal and state data on fatal and non-fatal overdoses for the past few months are not yet available, while coroners and medical examiners are overwhelmed with cases of Covid-19 and may not have the resources to follow up on overdose deaths, she said.
“We do not know,” Volkow said, of whether more people are overdosing in connection with Covid-19. “In many cases, we will likely never know.”
But she predicts that some communities will “absolutely” see an uptick in overdoses.
Public health services are disrupted
There are a few reasons that experts are concerned about a potential coronavirus-related increase in opioid overdoses.
For one, harm reduction programs across the country have been experiencing reduced capacity given the pandemic, Heller said.
Though many states have defined such services as essential in their stay-at-home orders, some programs have had to restrict access or reduce staffing because of a lack of funding or personal protective equipment for their workers.
Federal agencies have eased some regulations that have mitigated the risks of overdoses and Covid-19 infection, Heller said.
Still, for people who lack health insurance or high-speed internet access, there are barriers.
People are engaging risky behaviors
In some communities, services that treat addiction or prevent overdoses, such as needle exchange programs, are on hold — leading people to engage in risky behaviors.
Jamie Favaro is the founder of Next Distro, a harm reduction organization that provides syringes and the overdose-reversing naloxone online and through the mail. She said her organization is receiving about five times as many requests as usual because people haven’t had access to sterile syringes. A significant volume of requests is coming from people in Ohio, Kentucky and West Virginia, she said.
Recently, she said, a client in West Virginia requested syringes after sharing a single needle with three other people for a week. The exchange programs in their area were shut down, the client said, and there was nowhere else to get syringes. Other clients have reached out saying they are also reusing syringes or have had needles break off in their skin, she said.
“I’m very fearful that we’re going to see an HIV spike and a Hepatitis C spike, as well as an overdose spike in areas where the needle exchange programs have shut down,” Favaro said.
But the coronavirus pandemic presents challenges there as well.
When someone overdoses on opioids, another person generally administers naloxone to reverse those effects. Because of social distancing, Volkow said, it’s possible that some individuals may not have anyone else around to administer the life-saving medication.
The drug supply is affected
Another reason people are at heightened risk of opioid overdoses has to do with how Covid-19 has affected the nation’s illicit drug supply, experts say.
Less access to drugs could also drive users to seek out other, unfamiliar drug sources — or risk withdrawal.
Stress could drive people to relapse
Finally, the social isolation brought on by the coronavirus pandemic is leaving people especially vulnerable.
Some support groups for people experiencing opioid addiction or for those in recovery are now taking place over Zoom, Volkow said. But the virtual contact often just isn’t the same.
“One of the most powerful interventions is to keep people in treatment is that social network,” she said. “Isolation can lead you to seek out some relief, like starting to take drugs.”
It will be a while before we know the true effects that Covid-19 has had on those who struggle with opioid use disorders, Volkow said. But already, there are many reasons to worry.