Before COVID-19, the opioid crisis was one of the most frequently talked about public health challenges in America. It was a topic that had the attention of high-level stakeholders across the industry, generated a significant amount of funding opportunities for public and private organizations, and it was the target of numerous federal and state legislative bills.
In fact, in the course of two years, a deeply divided Congress passed two bipartisan laws to address the opioid crisis. The first came in July of 2016 with the Comprehensive Addiction and Recovery Act, authorizing the use of more than $180 million to respond to the opioid epidemic. Two years later, in October of 2018, Congress passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, another comprehensive bill addressing the crisis.
Naturally, COVID has changed people’s priorities. But while health care leaders have been appropriately focused on vaccines, mask mandates, COVID education and improving public-private collaboration since March 2020, the opioid crisis hasn’t gone away. In fact, according to recent CDC data, it has gotten worse.
“We’ve all been so focused on the global pandemic of COVID that we’ve really lost visibility to the opioid epidemic that is bubbling over in our country,” says Gerry Stanley, MD, CMO of Harvard MedTech. “It’s evident by the number of overdoses we’ve seen, not just from prescription opioid but with street drugs.”
The CDC recently released provisional data on the number of drug overdose deaths in 2020, and while some states have yet to report their information, it’s going to be the worst year on record with more than 93,000 overdose deaths, which represents a whopping 30 percent increase from 2019. Most of these deaths, the CDC says, come from opioid-related incidents. Mayo Clinic released its own data on non-fatal overdoses and found that while emergency visits on average decreased 14 percent in 2020, visits related to opioid overdoses increased by 10.5 percent.
“The number of overdoses we saw increased by a large amount—by about 10-11 percent,” says Molly Jeffery, PhD, a health economist and researcher at Mayo Clinic and one of the authors of the study. “While that doesn’t seem like much, at the same time emergency department visits had fallen off a cliff, especially in the early part of the pandemic. We did a study and found that across the country, regardless of how many COVID cases there were locally, everyone stayed home at the same time. People stopped going to the emergency department. In the early part of the pandemic, ED visits were down 40 percent across the country.”
Thus, when put into context with the reduction in ED visits, the increase is even more substantial, she notes, saying that it essentially equates to a 30-percent increase in overdoses relative to the drop off. “Things have gotten quite bad, and they continue to be bad,” Jeffery says. For the data, Mayo looked at EDs across Alabama, Colorado, Connecticut, North Carolina, Massachusetts, and Rhode Island.
Why it’s gotten worse
A 30-percent increase doesn’t happen in a vacuum. There were several reasons for this dramatic shift. The biggest driver for opioid overdoses in recent years is the proliferation of illicitly manufactured fentanyl, says Deni Carise, PhD, Chief Scientific Officer of Recovery Centers of America.
Pharmaceutical fentanyl has seen a reduction in prescriptions from doctors in the last few years thanks to the physician drug monitoring program, according to CDC data. However, Carise says illicitly manufactured fentanyl remains a huge challenge. Jeffery notes that disruptions in the drug supply chain during COVID may have also likely contributed to an increase in the supply of fentanyl in the formula of several drugs, not just heroin.
“Many of these illicitly manufactured fentanyl products are laced into cocaine, amphetamines, and even marijuana, often without the buyer’s knowledge. That actually started to tick up in 2019, but it got worse last year,” says Carise. “The field in general—people in treatment and recovery—were profoundly impacted by the pandemic.”
Indeed, COVID was a major factor in the increase of opioid-related overdoses. Carise says that people with substance abuse problems across the country lost their support systems during the pandemic. These undoubtedly led to an increase in relapses, she says. Jeffery agrees and adds that the interruptions in normal, day-to-day activities of someone who is recovering from drug abuse puts them at risk.
Furthermore, not only did they lose in-person access to the substance abuse recovery communities to which they belong, but they lost access to methadone clinics and other treatment programs, says Jeffery. “If you are getting methadone treatment, because of federal regulations you essentially have to go to the clinic every single day. You usually don’t get an appointment. You have to stand in line, you get a cup of liquid methadone so you can’t walk out and sell it. They are usually open early and not in great neighborhoods. You have to go, stand in line and hope you get out of there in time to go to your job,” says Jeffery. “When COVID hit, no one wanted to stand in line with a bunch of people they don’t know. Some of the treatment programs actually closed down.”
While there were some temporary changes from the Drug Enforcement Agency and the Substance Abuse and Mental Health Services Administration that allowed methadone clinics to give people take-home treatments, it wasn’t enough to curb the opioid related overdose rates. Recent research from Yale highlights how slow these clinics were in giving people access to treatment compared to facilities from Canada.
