“Everything we have to do to fight the coronavirus pandemic — social distancing, closing businesses, limiting gatherings — makes the overdose crisis worse,” said one expert.
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Illicit drug use and fatal overdoses are likely surging during the US coronavirus pandemic, report public health experts, pointing to new warnings from drug tests and health departments.
Fatal drug overdoses, largely driven by the synthetic opioid fentanyl, have killed around half a million people nationwide in the last decade. The coronavirus pandemic appears to be making this dire threat even worse for the millions of people in the US with substance use disorders tied to heroin, cocaine, and methamphetamines.
“The pandemic is ripping off the band-aid we have put on the overdose crisis,” said RTI International senior scientist Jon Zibbell, who studies illicit drug use. “Everything we have to do to fight the coronavirus pandemic — social distancing, closing businesses, limiting gatherings — makes the overdose crisis worse.”
“We actually have two epidemics,” Zibbell added, where overdoses are hidden amid the waves of coronavirus cases.
Fatal overdose numbers dropped slightly two years ago, a glimmer of hope in the overdose crisis declared a national public health emergency by the Trump administration. But they again resumed their march upward last year, according to preliminary CDC data, and now appear to have killed around 71,000 people in 2019. Raising alarm in May, an early report from the federally sponsored Overdose Detection Mapping Application Program found an average increase of 20% in overdose rates in six states for 2020.
The latest sign of more illicit drug use during the pandemic comes in a report of 500,000 urine drug tests from doctor’s offices reported last week by Millennium Health, a specialty lab that also performs sentinel reporting on illicit drug use for federal health agencies. The report found a 32% increase in illicit fentanyl results, a 20% rise in methamphetamine, and a 10% increase in cocaine positive test results nationwide from January to May. The numbers shot upward after the March 13 declaration of the COVID-19 national emergency.
Most alarming, the drug tests point to a geographic spread of fentanyl, an opioid 30 to 50 times more powerful than heroin now responsible for most fatal overdoses. While fentanyl has been predominantly found on the East Coast, the report suggests that it has now spread to the western half of the country. Methamphetamine use also seems to have spread from Appalachia toward both coasts.
“Fentanyl has jumped the Mississippi River,” said Millennium Health’s Eric Dawson. He acknowledged that the overall number from the testing results need to be taken with caution, because they come from people willing and able to be tested in doctor’s offices during the pandemic. But the increase appears to be holding up in their data from June as well, Dawson added, even as drug testing returned to more normal conditions when many state lockdown orders ended.
The reports add to recent evidence that illicit drug use is increasing during the pandemic, National Institutes on Drug Abuse Director Nora Volkow told BuzzFeed News. Other reports have shown that stress and isolation may be driving increased alcohol use and prescriptions for antidepressants and anti-anxiety medication, up 36% by May.
In particular, Volkow found the increase in methamphetamine positive test result numbers alarming, because of a lack of good treatment options for stimulants. Opioids at least have options like methadone and buprenorphine, milder opioids taken in “medication-assisted treatment” programs as people recover from substance use disorders.
Along with all the other tragedies resulting from COVID-19, the pandemic obscures the overdose crisis. “People are avoiding emergency departments for fear of infection,” Volkow said. People who have overdosed are therefore more likely to die, and more likely to suffer another overdose later if they survive, because they are not offered the treatment and recovery options they would get at a hospital. Fatal overdoses require testing to identify, and those tests are being delayed by health care systems struggling to set up testing for coronavirus.
All of the early data, however, suggest that the overdose deaths of 2019 “are going to be surpassed in 2020,” Volkow said.
One reason is that social distancing required for flattening the curve of coronavirus cases works against drug users, said Zibbell. “Addiction is the opposite of community. Social distancing makes isolation the new normal.” One key tenet of “harm reduction” approaches to drug use, for example, is to never shoot up alone because if you overdose alone, you might die alone, he said. “A lot of us are alone now,” Zibbell said.
The bottom line is that people who become physically dependent on opioids require regular doses of the drugs to stave off painful withdrawal symptoms whether there is a pandemic or not, Zibbell said. “People are going to take illicit drugs if they are going to be sick otherwise.”
Another factor that may be driving up overdose rates is changes to the supply chain. Much of the street fentanyl and methamphetamine sold in the US is smuggled by car and truck from Mexico, and border closures have meant the potency of drugs reaching the street varies wildly, accelerating a turn toward drug cartels smuggling fentanyl, which is more potent by the pound than heroin and easier to transport. Differences of a milligram in a hit of fentanyl can be fatal, making swings in its potency very dangerous.
Industrial-strength methamphetamine is also easier to smuggle, and US Customs and Border Protection announced this month that for the first time ever, it had seized over 100,000 pounds of methamphetamine in a fiscal year, with three more months left for reporting.
The pandemic is also making it harder for people to go into recovery. Treatment centers are seeing fewer new patients because of fears around the virus’s spread, and social distancing limits the group therapy discussions that are a hallmark of many recovery programs.
The only silver lining in the crisis is that many states have moved to open up more prescriptions for medication-assisted treatment drugs, said Volkow, allowing buprenorphine, a milder opioid that prevents withdrawal, to be prescribed by telemedicine and allowing mobile sites to deliver methadone to people in recovery.
These “natural experiments” are being monitored under emergency grants from her institute to see which approaches are most effective at saving lives and encouraging treatment for addiction, she said.
But things are more likely to get worse before they get better, especially after federal economic benefits during the pandemic end in August.
“As people are losing jobs and facing eviction, we are going to see a rise in the homeless population,” said Volkow, stressing that people who are unhoused are vulnerable both to the coronavirus and to overdoses. “That is another element we need to keep our eyes on.”