Overdose: The Intersection of COVID-19 and the Opioid Epidemic

When the coronavirus pandemic arrived in the United States, many of us forgot our nation was in the middle of another public health crisis: the opioid epidemic. In early 2020, we’d made some significant progress addressing the epidemic. Local, state, and federal authorities worked together to streamline regulations, expand access, and remove barriers to treatment for people with opioid use disorder.

That’s where we were when the coronavirus pandemic hit. Making progress. We collaborated and planned across many levels. We put plans into action. After a decade of increasing overdose fatalities, the result of our efforts included decreases in overdose deaths from 2017 to 2018:

· A 4% decrease in drug overdose fatalities nationwide:

o 70,237 in 2017

o 67,367 in 2018

· A 2% decrease in opioid-related overdose fatalities nationwide:

o 47,600 in 2017

o 46,802 in 2018

I won’t Pollyanna the situation: while the big-picture numbers decreased from 2017 to 2018, overdose deaths involving synthetic opioids increased. However, the largest decrease in synthetic opioid-related deaths occurred in Ohio, one of the regions hardest hit by the epidemic.

That was good news for Ohioans.

However, since the arrival of coronavirus in the U.S., specific areas of Ohio have seen an increase in opioid overdose deaths. In fact, one county coroner in Ohio reported seven overdose deaths in a 24-hour period.

That is not good news for Ohioans.

How COVID-19 Rules Increase Overdose Risk

Anyone who works in public health in the U.S. knows nothing involving policies that affect more than three hundred million people is simple. When you work to increase safety in one area, you may unintentionally increase risk in others. It’s a conundrum at the heart of public health in our country, with a diverse population living in a wide variety of conditions across a range of geographic, social, and economic circumstances.

I see this challenge firsthand in our response to the coronavirus pandemic. Some measures that are necessary for public health and safety — such as shelter-in place orders and social distancing — have negative consequences for people with opioid use disorder.

Harvard physician Peter Greenspoon wrote an article that describes how both COVID-19 and our public response increases risk of relapse and overdose for people in treatment for opioid use disorder.

He identifies four factors that contribute to increased risk:

1. Disruption in Treatment and Support

2. Isolation-Related Stress

3. Overwhelmed Healthcare System

4. Social Determinants of Health.

These four factors are real. I deal with them every day, and it’s incumbent upon doctors like me to offer additional support during the coronavirus pandemic. Thankfully, the American Medical Association (AMA) agrees with me.

The AMA Issue Brief

On May 18, 2020, the AMA published a report that confirms fears addiction specialists had when we first went into COVID lockdown. The report offers three examples of national media reports about overdose, and 34 local reports from 26 states about COVID-related spikes in opioid-related mortality and overdose death.

In response to this situation, the AMA advises states to take the following four action steps:

1. Use new COVID rules.

2. Be proactive.

3. Address Pain Medication Issues.

4. Increase Harm Reduction Strategies.

Click here to read the complete guidelines published by the AMA that offer specific details for policy makers about how to implement these recommendations.

Nationwide Coordination: A Template

In response to the opioid epidemic, our nation collaborated on a coordinated response that extended from front-line police officers and EMTs to the highest levels of government. Ideas from small rural towns made it all the way up the chain of command. The best of those were included in federal policies and guidelines implemented across the entire country. Public-private partnerships formed between local, state, and federal governments: non-profits, healthcare providers, pharmaceutical companies, and insurance companies all participated.

This level of top-to-bottom integration helped us reduce harm for our most vulnerable citizens: the proof is in the decrease in overdose deaths from 2017–2018. Our work on the opioid epidemic proves that when we work together, we can create and implement policies that — despite the challenges — support the health and wellbeing of all citizens.

However, I haven’t seen anyone, anywhere, point out the fact that our response to the opioid crisis could serve as a template for managing our current public health crisis.

Perhaps the connection is a stretch.

Perhaps I’m comparing apples and oranges.

What do you think?

By Chris Johnston, MD ABPM-ADM, Chief Medical Officer, Pinnacle Treatment Centers