Opioid Epidemic and COVID-19 Pandemic: Dual Crises

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A recent USA Today opinion piece posed a pressing question: “America is still in the middle of an opioid epidemic. Why did we stop talking about it?” Here is a brief recap of the opioid epidemic before COVID-19 and the latest information on the impact of COVID-19 on the opioid epidemic.

According to the Centers for Disease Control and Prevention (CDC), opioid-involved overdose deaths increased almost six times from 1991 to 2018, peaking at 47,600 deaths in 2017 and holding steady at 46,802 deaths in 2018. In that span, 446,032 people died from an overdose involving opioids. Preliminary data for 2019 show more than 50,000 opioid overdose deaths.

Since the onset of the COVID-19 pandemic, 13.1 percent of U.S. adults reported initiation or increased use of substances. CDC conducted a survey (220 KB) in June 2020 to assess the impact of COVID-19-related morbidity and mortality on U.S. adults, as well as effects of physical distancing and stay-at-home orders issued to mitigate the pandemic. In addition to substance use, the survey found elevated reports of suicidal ideation and symptoms of anxiety, depression, stress, and trauma.

Findings of an NIH analysis of electronic health records show that people with substance use disorder (SUD), including those with opioid use disorder (OUD), are more vulnerable to the coronavirus than individuals without SUD. Those with SUD are more likely to both develop COVID-19 and experience worse outcomes (e.g., hospitalization and death). The analysis also found that of individuals with SUD, those with OUD are the most likely to develop COVID-19.

This JAMA article and this episode of FDA Insight discuss how financial and economic stressors of COVID-19 have affected people with OUD. The COVID-19 pandemic introduced several barriers to accessing OUD treatment services, medications that treat OUD, and recovery support, including loss of employment and health insurance coverage, closure of healthcare facilities, and disruption of public transportation services.

An issue brief from the American Medical Association (702 KB) shares media reports of increases in opioid-related overdoses in more than 40 States during the COVID-19 pandemic. This Minnesota Department of Health report shows statewide drug overdose deaths increased 31 percent from January to June 2020, compared with the same period in 2019. Real-time data on opioid overdoses and overdose deaths are not available, but preliminary data from the National Vital Statistics System indicate that the rate of overdose deaths involving opioids increased nationally in the first few months of 2020.