Long before COVID-19 was a household word, the United States faced another deadly epidemic: the opioid crisis. In 2018, an estimated 47,600 people in the U.S. died of an opioid-related overdose. Unfortunately, the latest numbers of overdose fatalities are almost double that. Studies show that over 90,000 people died of a drug overdose in 2020 and sadly the projection for 2021 is even grimmer. Currently, over two million 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 Epidemic and COVID-19
When COVID-19 hit last March, the U.S. was already facing another frightful public health crisis — the opioid epidemic. Between the isolations caused by lockdowns, economic insecurities, and other unexpected consequences of the pandemic, overdose deaths soared. Experts predict that around 90,000 people died of a drug overdose in 2020, sadly a new record of the highest number of fatalities and the most significant increase in one year.
Understanding the Opioid Epidemic
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 of the opioid crisis, enough prescriptions were written in a year for every adult in the U.S. to have a bottle of pills.
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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 synthetic opioid use rates. 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 the unemployed, homeless, or housing insecure, living with a mental health condition, or 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, social and psychological factors 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 insecurities. Children were left without school or reliable child care.
These social factors placed a considerable degree of stress on all Americans. Many people with mental health conditions reported a worsening of symptoms. Simultaneously, 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 massive uptick in opioid use disorder during the COVID-19 pandemic. Early reports from counties worldwide 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 untangle the complex relationship between COVID-19 and opioids usefully.
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 risky behaviors such as smoking or vaping, which can worsen lung function and COVID-19 outcomes.
Moving Forward to Combat COVID-19 and the Opioid Epidemic
As the IHME data shows, COVID-19 continues to plague us in different strains and forms. Although we successfully developed an effective vaccine at a miraculous speed, we are still facing several challenges. Unfortunately, we must continue to remain vigilant to prevent the spread of this deadly virus. As we adapt to what life became after the world suffered the deadly effects of COVID-19, we cannot forget other health issues that also plague our country, particularly the opioid epidemic.
Throughout the last decade, many people use opioids to numb their physical pain and untreated mental health problems. Now, the economy is worsening, people are struggling to feel safe, and unfortunately, many have become homeless. Rather than allowing the coronavirus pandemic to rage unchecked, we must take action to protect the most vulnerable.
Finding a Solution to the Opioid Crisis
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 mental health and 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 education. 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 mental health, opioid use, and coronavirus. We need to advocate and create programs to best protect those at most significant risk for opioid abuse and COVID-19. A crisis creates an opportunity to change what is not working. This difficult time also allows us to rethink our priorities and concentrate on the future of those among us who are most vulnerable and in need of immediate help.