COVID-19 Seems to Have Exacerbated Opioid Epidemic, Researchers Find | Healthcare Innovation

Studies done in California and North Carolina by nonprofit research institute RTI International detail some of the ways the COVID-19 pandemic exacerbated the ongoing opioid pandemic.

RTI International partnered with the North Carolina Agricultural and Technical State University, and the National Institute of Mental Health on research that found that indicators used to measure severity of the opioid crisis increased sharply in Guilford County, North Carolina, during the pandemic.

Specifically, the research team found that the occurrence of Emergency Medical Services (EMS) runs for opioid-related overdoses increased 37.4 percent in a 29-week period beginning March 10, 2020 (the date of NC’s COVID-19 state of emergency declaration), compared to the preceding 29 weeks. Cases requiring EMS to administer naloxone, a life-saving opioid overdose reversal medication, increased by 57.8 percent and calls that required multiple naloxone administrations increased 84.8 percent in the same comparison of timeframes.

Overdoses requiring multiple uses of naloxone are inferred by researchers to be more severe than those only requiring one administration of the medication.

“To our knowledge, this is the first study to show an increase in opioid overdoses and the severity of opioid overdoses,” said Dalia Khoury, Ph.D., in a statement. Khoury, a behavioral health researcher at RTI who led the study, added that “based on our analysis, it appears the pandemic made a bad situation even worse, at least in Guilford County. It is worth continuing to explore how and why the pandemic had this effect on the opioid crisis in other counties, states, as well as nationally.”

The researchers outline possible reasons for the pandemic’s association with an increased incidence and severity of opioid overdoses, including social isolation, a decrease in tolerance caused by limited availability of opioids during the pandemic, and reduced access to treatment, but assert that more research is needed.

“More broadly, our study reaffirms the value in sharing data between public health and safety, research, community, and academic organizations to help track the opioid crisis,” added Khoury.

Another  RTI study published in the Journal of the American Medical Association found that addiction treatment providers in California saw a 28 percent drop in patients initiating treatment in the eight months after the start of the pandemic relative to the year before. By October, 2020 treatment initiations had still not returned to pre-pandemic levels.

“COVID-19 had a devastating effect on access to addiction treatment, which may have contributed to the acceleration in overdose deaths over the same time period,” said Tami Mark,  Ph.D., senior director, behavioral health financing at RTI, in a statement. “Federal, state and local governments need to ensure that access barriers have been removed. In the future, addiction treatment should be classified as an essential service to avoid similar disruptions following disasters and public health emergencies.”

Researchers found larger declines in addiction treatment program initiations among individuals with criminal justice involvement, who had recently been released from prison, who were referred from driving under the influence programs or drug courts, and who were referred from child protective services and other community sources. The findings highlight the disruption that COVID-19 caused in the criminal justice and social service systems as prisons, courts, and child protective services curtailed efforts to connect individuals to addiction treatment.

Larger declines also occurred among individuals without Medicaid coverage underscoring the importance of Medicaid in facilitating access.

The authors outline lessons learned for future public health emergencies, including federal and state government prioritization of addiction treatment as an essential service, better disaster planning by the criminal justice and social welfare systems, greater public outreach and assurance about the importance of addiction treatment, expansion of financing for telemedicine and remote treatment.