COVID-19 Causes Opioid Shortage, Creates New Risks

COVID-19 Pandemic and Opioid Epidemic

The COVID-19 pandemic has brought unexpected consequences for many aspects of society. One of the biggest changes has been the face of the ongoing opioid epidemic. Prior to the pandemic, tackling the opioid crisis was the federal government’s top health priority. Now, all efforts focus on slowing the spread of COVID-19. The opioid crisis has taken a back seat. As a result, the most vulnerable people in our society are at high risk with few resources to depend on.

Effect of Stay-At-Home Orders on Opioid Supply and Demand

California became the first state to issue shelter-in-place orders beginning in mid-March 2020. Within several weeks, dozens of states followed suits. While the rules differed between states, many patients were unable to attend regularly scheduled doctor’s visits. Opioid medication treatment programs (e.g., methadone or suboxone clinics) closed their doors or restricted the number of patients they could see. Many residential treatment programs turned to a virtual format or stopped accepting patients. In an effort to contain the coronavirus, people struggling with addiction lost the services they need to survive.

For those still using opioids, access to their usual suppliers quickly stopped. The reasons for this have to do with the complex global network that supplies street drugs to the United States. Synthetic opioids like fentanyl are produced in laboratories in China. Wuhan, China, the city in which COVID-19 originated, is one of the biggest producers of synthetic opioids. As the coronavirus pandemic spread and Wuhan locked down, production of fentanyl and other synthetic opioids stopped.

Heroin, too, has been affected by the pandemic. Southeast Asia and Afghanistan are the biggest producers of heroin. From there, it makes its way to Mexico. Powerful drug cartels then traffic it across the U.S.-Mexico border, where it is distributed throughout the country. The steep decline in land traffic between the United States and Mexico has led to a sharp decline in the availability of heroin.

People buying heroin or other opioids face another hurdle: empty streets and a greater police presence mean it’s tough to meet up with dealers. According to law enforcement agents across the country, the illicit opioid trade has almost completely dried up. Plus, the economic downturn and mass unemployment mean that people simply don’t have the money to support their drug addiction.

A Vulnerable Group at Risk During the COVID-19 Pandemic

The combination of the opioid shortage and decreased access to mental health treatment created a perfect storm for people struggling with addiction. Some individuals, unable to get their usual drugs, sought medication-assisted treatment with methadone or suboxone to avoid withdrawal symptoms from going “cold turkey.” Sadly, this type of treatment simply puts a Band-Aid on the problem by swapping one addiction for another. Furthermore, entering treatment out of sheer desperation rarely leads to long-lasting recovery.

The supply chain disruption creates another major risk for people struggling with opioid addiction. When an addicted person cannot get their usual product from their usual dealer, they try to find another source. That changes several variables: the strength, dose, and quality of product can vary widely. Suddenly, a person may take the same amount of drug that they used previously, only to find that it is much more potent. The result can be an unexpected overdose.

A similar problem happens when states begin to ease stay-at-home restrictions. As businesses reopen and things return to a new normal, opioid supplies will also increase. But people who have been without their usual drugs may underestimate how much a period of abstinence has changed their bodies. Being drug-free for even a few days or weeks can change the sensitivity of opioid receptors. When a person uses drugs again, the receptors may be more sensitive to small amounts of the drug. Many people returning to drug use after a period of sobriety accidentally overdose because of this.

Indeed, initial reports from communities across the country suggest that the COVID-19 pandemic has increased risk of opioid overdose. Compared to the same time in 2019, the first quarter of 2020 brought an 11% increase in overdose deaths and a 18.6% increase in non-fatal overdoses, according to data from the Office of National Drug Control Policy. As the pandemic continues, unemployment, depression, pain, and despair may fuel an even greater risk in opioid use and overdose.

Even more painful, there are concerns that people suffering an overdose may not get the lifesaving treatment they need. Naloxone nasal spray is widely used to reverse an opioid overdose. The rapid administration of naloxone knocks opioid molecules off their receptors, increasing breathing rate to prevent death. However, administering naloxone requires close contact with the person to deliver the drug into the nose. Because COVID-19 is spread via nasal droplets, some emergency responders are concerned that delivering life-saving naloxone could increase their risk of coronavirus.

A Path Forward: Continuing the Fight Against Opioid Addiction

Lessons learned from the COVID-19 pandemic don’t just apply to new viruses or infectious diseases. The pandemic also exposed the many ways in which our society fails the most vulnerable. People struggling with addiction are more likely to die from coronavirus, cannot get the mental health treatment they need and are at high risk of overdose. They are also more likely to be economically vulnerable, meaning that even a slight downturn could lead to homelessness, loss of insurance coverage, and interruption of medical services.

For too long, we have allowed mass trafficking of drugs across our southern border with Mexico. Drug dealers’ convenience and profits kept opioids flowing into the United States. Poor global regulation allows for massive production of synthetic opioids in China. These international issues make it challenging to fight against the opioid epidemic in our local communities. Even worse, millions of people are vulnerable to addiction due to poverty, depression, anxiety, trauma, homelessness, and related issues. Until we treat the underlying causes of opioid addiction, we will continue to fail.

Sadly, most treatment programs for opioid addiction offer ineffective treatments that prey on the vulnerable. Methadone and suboxone are forms of opioids. They bind more tightly to opioid receptors but have a weaker effect. That means that taking these medications prevents withdrawal symptoms without the “high” that a person gets from taking heroin or fentanyl. Unfortunately, by acting on the opioid receptors, these drugs keep a person physiologically dependent on opioids. That means that someone taking methadone must continue to take the drug to prevent withdrawal or possible relapse. It’s simply a way of replacing one addiction with another, without addressing the underlying problem.

What we need is a coordinated approach to treating opioid addiction that places the person at the center of treatment. Individualized, compassionate treatment options like medically assisted detoxification allow a person to undergo withdrawal in a safe, caring environment. Once all of the opioids have been cleansed from the system, the person can begin meaningfully working on addressing the underlying causes of addiction. Mental health treatment focusing on trauma, depression, anxiety, and other mental disorders is the best way to prevent relapse. Learning the skills to replace opioids with healthier forms of coping will help people transition back to a regular, drug-free life.

It’s time to take action. Rather than ignoring the opioid epidemic to focus on the COVID-19 pandemic, we can fight both together. It is critical to increase access to effective drug detoxification and treatment, mental health care, and community resources to support people suffering because of addiction.