Long before COVID-19 was a household word, the United States was facing down another deadly epidemic: the opioid crisis. In 2018, an estimated 47,600 people in the U.S. died of an opioid-related overdose. Two million more are living with an opioid use disorder. The arrival of the COVID-19 pandemic has only made the situation worse, creating a public health emergency.
Opioid Abuse Left the American People Vulnerable to COVID-19
The roots of the opioid epidemic began in the 1990s. Pharmaceutical companies lobbied aggressively to convince doctors that prescription opioid painkillers were safe and effective. Doctors responded by prescribing millions of doses of opioids to their patients. At the peak, there were enough prescriptions written in a year for every adult in the U.S. to have a bottle of pills.
Of course, we now know that prescription painkillers are not nearly as safe as advertised. Taking these drugs for chronic pain causes your body’s opioid receptors to change. They become used to having lots of opioid molecules floating around. As a result, you need larger doses to get the same effect. This physiological tolerance caused many people to seek out cheaper, more potent sources of opioids to get the numbing, pain-killing effect. Soon, rates of heroin abuse began to spike. More recently, a third wave of the opioid epidemic hit, with accelerating rates of synthetic opioid use. Synthetic opioids such as fentanyl have killed thousands of people over the past few years.
The millions of people affected by the opioid epidemic are particularly vulnerable to COVID-19. Substance use disorder can affect anyone, man or woman, of any age, race, or socioeconomic status. However, many people first start using opioids to dull physical or emotional pain. It is no surprise that opioid abuse is higher among people who are unemployed, homeless or housing insecure, living with a mental health condition, or in financial distress. Opioid use can make those factors worse by making it challenging to hold a job, maintain stable relationships, and pay for everyday needs. As COVID-19 sweeps through the country, it is taking its toll on these more vulnerable Americans.
COVID-19 and Opioid Use Disorders May Interact
Opioids affect your entire body, particularly the respiratory system, brain, and gastrointestinal system. When a person takes opioids, the drug molecules send signals that blunt pain. At the same time, they cause breathing to slow and become more shallow. This change in respiration is the primary cause of overdose deaths. People who take too high a dose of opioids die because their breathing slows or stops altogether.
As a respiratory virus, COVID-19 severely compromises lung functioning. One of the hallmark symptoms is shortness of breath and a dry cough. For people with opioid use disorder, lung functioning may not be optimal to begin with. That means that people with opioid addiction may be particularly vulnerable to respiratory infections like coronavirus. They may also have more severe symptoms when infected with COVID-19.
In addition to the physiological links between opioid use disorder and COVID-19, there are social and psychological factors that link the two conditions. The COVID-19 pandemic in the United States unfolded rapidly. Within a few weeks, millions of people were under stay at home orders. Simple activities like pumping gas or going to the grocery store became health risks. Millions of people lost their jobs, and many face housing insecurity. Children were left without school or reliable child care.
These social factors placed a huge degree of stress on all Americans. Many people with mental health conditions reported a worsening of symptoms. At the same time, access to mental health care was restricted as psychologists and medical providers had to shut their doors. Faced with immense emotional pain, many people chose to use opioids to numb their emotions. People in recovery returned to their old habits, and others began experimenting with opioids for the first time.
Together, these factors have led to a huge uptick in opioid use disorder during the COVID-19 pandemic. Early reports from counties around the country show a 20% increase in opioid overdose deaths since the beginning of the pandemic. Of course, like all of the research coming out about COVID-19, there is a lot we still do not know. It will take time to fully untangle the complex relationship between COVID-19 and opioid use.
Scientists at the National Institute on Drug Abuse and other research organizations are actively investigating these questions. The need for telemedicine means that many people are being dispensed medications without typical oversight. Medication-assisted therapy like methadone or buprenorphine clinics have changed how they do business. Patients now receive these controlled substances with much less guidance than before. Researchers are studying whether this will lead to bad outcomes, but we will not know the answers for months or years. People with opioid use disorder may also engage in other risky behaviors such as smoking or vaping, which can worsen lung function and COVID-19 outcomes.
Moving Forward to Combat COVID-19 and Opioid Abuse
COVID-19 is here to stay for the near future. Until we develop an effective vaccine, we must continue to stay vigilant to prevent its spread. As we adapt to the “new normal,” we cannot forget the victims of the opioid epidemic. Many of these people were already left behind by the Great Recession, numbing their pain and untreated mental health problems with drugs. Now, the economy has worsened, people are struggling to find work, and many are in danger of losing their homes. Rather than allowing the coronavirus pandemic to rage unchecked, we must take action to protect the most vulnerable.
But what does that look like? The problem is complex, and so is the solution. One critical part of the solution must be increasing access to effective treatment for opioid abuse. Letting people continue to struggle will only make the opioid crisis worse.
We need to provide effective, evidence-based care like Waismann Method®. The Waismann Method allows patients to undergo detox in a comfortable, supportive hospital environment. Once the opioids are cleared from their systems, patients are in the right space to work on the problems that drive addiction. That means treating unmet mental health needs, increasing social ties, and improving access to community resources. Only by treating the whole person, rather than a cluster of symptoms, will we make progress in the fight against opioid abuse.
We also need more information. We are learning more about the COVID-19 virus each day. Given the enormous burden of opioid abuse in our country, we must focus resources on better understanding the link between opioid use and coronavirus. The National Institute on Drug Abuse has already begun to fund special research programs into these issues. We need to advocate for even more funding to learn how to best protect those at greatest risk for opioid abuse and COVID-19. This is an opportunity to invest in our future and the future of those among us who are most vulnerable and in need of our help.