How the COVID Pandemic Made the Opioid Epidemic Worse, Even as Telehealth Helped
The COVID-19 pandemic has shaken up the U.S. opioid crisis in ways bad and good, increasing the risk of use and overdose but also spurring innovative approaches to treatment.
The pandemic has definitely been linked to an increase in opioid use and overdose deaths, Tufts University's Thomas Stopka said during a HealthDay Now video interview.
"We've been seeing increases in opioid overdose deaths over the past 15 to 20 years, but the increase from 2019 to 2020 was upwards of a 30% increase, from about 70,000 the previous year to 93,000 in 2020," said Stopka, an associate professor of public health and community medicine at Tufts School of Medicine in Boston.
People have often turned to alcohol, opioids and other drugs to help them cope with the pandemic, he said.
"We were all stressed out about the pandemic, and about infection coming into our neighborhoods, into our homes, into our families," Stopka said. "That seemed to have an impact on substance use practices."
For opioid users, the pandemic created an added risk by disrupting supply chains for illicit drugs, he noted. It's very similar to the way COVID-19 caused shortages in food, toilet paper and other necessities.
"Folks who might have relied on a traditional pattern of supply over many years now might have had breakage in that supply, because maybe overall supply chains were also decimated by people getting sick, people taking care of their loved ones," Stopka said. "If folks couldn't rely on their typical source of illicit opioids, then they don't know exactly what they're getting."
Opioids from new sources increase a person's risk of overdose because the drugs could be cut with more powerful substances like fentanyl, a synthetic opioid that's up to 100 times more powerful than morphine.
"People don't always know what they're getting," Stopka said. "There's a pretty good chance there's going to be fentanyl in heroin, and it might be cut with other things."
But the increase in fentanyl-tainted drugs might have contributed to another COVID-era trend — more people seeking earlier treatment at programs that have developed greater flexibility in response to pandemic-era challenges, said Zachary Talbott, president of Talbott Legacy Centers, a drug treatment program in Maryville, Tenn.
"We're having people come into treatment after a year of problematic use, whereas prior I would have people with a history of 10 years, 12 years, 15 years," Talbott said in a HealthDay Now interview. "I think in some ways the increase in overdoses — we hear this from patients across the region — has scared them."
COVID-inspired social distancing requirements also have made it easier for people to get treatment for substance use disorder, Talbott and Stopka said.
For example, the pandemic spurred a dramatic increase in telehealth services in all medical fields. People struggling with substance use particularly benefited from the ability to get remote care, the experts said.
A former opioid abuser himself, Talbott recalled that he used to drive as much as four hours a day going to and from treatment.
"That goes back to my privilege," he said. "That's not achievable for the vast majority of people who don't have a car that can make such a drive, who would have to work, don't have family or other resources."
The HealthDay Now interview can be viewed below:
But virtual health care isn't perfect.
"We have a lot of folks in rural areas or more impoverished areas in Appalachia that just don't have the technology or data plans to do telehealth," Talbott said.
The U.S. Centers for Medicare and Medicaid have "allowed audio only during the pandemic, but you cannot engage in follow-up in the same way — that, to me, has been limiting," Talbott continued.
"We can still do a lot of good stabilizing of the brain with medication, but it's all the stuff that comes after that that really makes for a lasting recovery plan," he said. "We struggle during the pandemic to continue to the same level."
But the availability of telehealth, combined with expanded federal coverage of addiction treatment, has made it much easier for people to get the help they need, the experts said.
Medicare and Medicaid now cover all three medications approved by the U.S. Food and Drug Administration to treat opioid use disorder, Talbott said. Those are methadone, buprenorphine and naltrexone.
To help with social distancing, the federal government also started allowing treatment centers to hand out take-home doses of the medications.
Until now, people had to go to their center every day to receive their dose of methadone, Stopka and Talbott said.
The take-home doses allowed treatment centers to more quickly and efficiently handle patients on methadone, Talbott said.
"We could stagger half of those that normally would be daily in that first early period to Monday, Wednesday and Friday, and the other half to Tuesday, Thursday, Saturday, so we could cut in half on these days the number of patients," he said. "Those that were stable on their dosage, we could go ahead and do a week even."
The concern now is that when the pandemic winds down treatment centers might lose some of this government-granted flexibility, Stopka said.
"If folks are having success with the take-home doses and having success with the telemedicine visits, and now they have to revert to going back to the clinic more frequently, then there are some folks that might not have the ability to drive to the clinic, particularly in places where you might have to drive two hours each way," Stopka said.
The U.S. National Institute on Drug Abuse has more about COVID-19 and substance use.
SOURCES: Thomas Stopka, PhD, MHS, epidemiologist and associate professor, public health and community medicine, Tufts University School of Medicine, Boston; Zachary Talbott, MSW, president, Talbott Legacy Centers, Maryville, Tenn.