A crowd gathers on the Capitol steps to remember loved ones who have been lost to opioid and drug abuse. (Capital Star photo by Cassie Miller).
By Brian King, Andrea Rishworth, and Ruchi Patel
Since the first diagnosed COVID-19 case in the US on January 20, 2020, news of infection rates, deaths and pandemic-related economic hardships have been part of our daily lives.
However, there is a gap in knowledge about how COVID-19 affected a public health crisis that existed before the pandemic: the opioid epidemic. Prior to 2020, an average of 128 Americans died from an opioid overdose every day. That trend accelerated during the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.
We are a team of health and environmental geography researchers. When social distancing began in March 2020, addiction treatment experts were concerned that shutdowns could lead to an increase in opioid overdose and deaths. In our latest study in the Journal of Drug Issues, we take a closer look at these trends by examining opioid overdoses in Pennsylvania before and after the statewide home order.
Our results suggest that this public health response to COVID-19 had unintended consequences for opioid use and abuse.
History of the opioid epidemic
Opioid abuse has been a major health threat in the United States for over two decades, affecting rural areas and white populations in particular. However, a recent shift in the drugs involved, from prescription opioids to illegally manufactured drugs such as fentanyl, has caused the epidemic to spread to urban areas and among other racial and ethnic groups.
From 1999 to 2013, rising drug abuse death rates, particularly among those ages 45 to 54, contributed to the first decline in life expectancy for white non-Hispanic Americans in decades.
Prescription opioid overdose mortality declined slightly nationally from 2017 to 2019, but the COVID-19 pandemic has undermined many of those advances. As one of our public health partners told us, “We made progress until COVID-19 hit.”
How are the legislators of Pa. Addressing the Opioid Crisis with New Emergency Response Guidelines?
We believe this is an urgent need for research on the links between policy responses to COVID-19 and patterns of opioid use and abuse.
Opioid use increases during the pandemic
Pennsylvania is one of the states hardest hit by the opioid epidemic. It had one of the highest death rates from drug overdose in 2018 at 65%, a total of 2,866 deaths involving opioids.
The state stay-at-home order, implemented on April 4, 2020, required residents to stay in their homes, practice social distancing and wear masks outside of the home whenever possible. All schools switched to distance learning and most companies had to work remotely or close. Only the essential services were allowed to continue to be operated personally.
In the months that followed, general public collaboration with these mandates contributed to measurable decreases in coronavirus infection rates. To understand how these regulations affected opioid use, we evaluated data from the Pennsylvania Overdose Information Network for changes in monthly incidents of opioid overdoses before and after April 1, 2020. We also looked at changes by gender, age and race, drug class, and doses of naloxone given. (Naloxone is a widely used drug used to reverse the effects of an overdose.)
Our analysis of both fatal and non-fatal cases of opioid-related overdose from January 2019 to July 2020 found a statistically significant increase in overdose cases in both men and women, whites and blacks, and in multiple age groups, particularly those 30-39 year olds and 40-49 groups after April 1st. This means that overdoses have accelerated in some of the populations most affected by opioids prior to the COVID-19 pandemic. But there was also uneven growth among other groups, such as blacks.
We found statistically significant increases in overdoses with heroin, fentanyl, fentanyl analogues or other synthetic opioids, pharmaceutical opioids and carfentanil. This is in line with previous research on the major classes of opioids that are contributing to increases in drug overdose and death. The results also confirm that heroin and synthetic opioids like fentanyl are now the greatest threats to the epidemic.
When a pandemic and an epidemic collide
While we saw a significant change in opioid overdoses during the COVID-19 pandemic, the results say less about some of the driving factors. In order to better understand this, we have been surveying healthcare providers since December 2020.
Important factors they highlight as contributing to increased opioid use include pandemic economic hardship, social isolation, and disruption to personal treatment and support services.
Pa. Opioid deaths have increased during the COVID-19 pandemic, officials say
From March to April 2020, the Pennsylvania unemployment rate skyrocketed from 5% to about 16%, peaking at more than 725,000 jobless claims in April. As job closings made it harder to pay for housing, food, and other needs, and opportunities for personal assistance disappeared, some people turned to drugs, including opioids.
People in the early stages of treatment or recovery from an opioid addiction may be particularly prone to relapse, suggested one of our public health partners. “Maybe they work in closed industries, so they have financial problems … [and] Additionally, they have their addiction problems, and now they don’t like going to meetings and making those connections. ”(Following our clearance with Penn State to conduct research on humans, our public health informants are kept anonymous.)
An addiction treatment counselor told us that, particularly for those with previous or current opioid use problems or a history of mental health problems, “It is not good to be alone with your own thoughts. And as soon as everyone was locked up, so to speak, depression and anxiety came. “
Another counselor also pointed out depression, anxiety, and isolation that led to increased opioid abuse. The pandemic “just got everything out of control,” they said. “Overdose high, everything high, everything.”
One question is whether states like Pennsylvania will continue to support telemedicine in the future. While the transition from personal to telemedicine services has improved access to treatment for some, it has posed challenges for populations such as rural and elderly people. As one vendor explained, “It’s really hard for that [rural] Population out there ”to use telehealth services due to limited internet and broadband connectivity. In other words, flexible forms of addiction treatment might work for some but not for others.
The aim of our research is not to criticize efforts to contain the spread of COVID-19. Without the mandatory Pennsylvania home order, both the infection and death rates would have been worse. However, our research shows that such interventions have unintended consequences for addicts and emphasize the importance of a holistic approach to public health as policymakers work to tackle both COVID-19 and America’s addiction crisis.
Brian King is a professor of geography at Penn State University. Andrea Rishworth is a postdoctoral fellow in geography at McMaster University. Ruchi Patel is a Ph.D. Student of Geography at Penn State University. You wrote this piece for The Conversation, where it first appeared.
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