How the COVID-19 pandemic triggered an increase in opioid overdose deaths
Dr Laura Kehoe
The United States Centers for Disease Control and Prevention recently reported 93,980 drug overdose deaths in 2020, a record high. That’s about 5,000 people less than the population of Erie, Pennsylvania. The number of overdose deaths, up from 70,890 in 2019, marks the largest annual increase in at least five decades. Federal authorities have attributed nearly three-quarters of fatal opioid overdoses. Many deaths were associated with fentanyl, a powerful designer drug. Overdose deaths from methamphetamine and cocaine use have also increased.
Dr Laura Kehoe, Medical Director of the Massachusetts General Hospital Substance Use Disorder Bridge Clinic(Courtesy of Massachusetts General Hospital)
As told to Ruben Castaneda, as part of US News & World Report’s “One Pandemic Question” series. Answers have been edited for length and clarity.
Q: How has the COVID-19 pandemic affected the opioid crisis?
The COVID-19 pandemic has exacerbated the many challenges faced by people with any substance use disorder, not just opioids. Most distressing is that overdose deaths have skyrocketed.
Before the pandemic, the “opioid” crisis had turned into a crisis of all substances. Multiple drug addiction is now the norm. The vast majority of my patients consume several substances – it could be a primary opioid use disorder with intermittent cocaine or methamphetamine and alcohol use – or several substance use disorders coexisting at the same time. Fentanyl, which is 100 times more potent than heroin, has poisoned the drug supply, putting anyone who uses drugs at risk of overdosing every time they take them.
Social distancing for people who use drugs has increased social isolation and hopelessness, both of which fuel addiction. For people with opioid use disorders, going days to weeks without opioids lowers their tolerance, putting them at a higher risk of overdose when they regain access to opioids. To compensate for and self-treat the painful withdrawal without opioids, people can use any other available substance such as alcohol and sedatives, which further increases their risk of overdose. We have seen a lot of this.
Vulnerable and marginalized patients experiencing homelessness have been particularly affected and are the ones that concern me the most. At first, shelters and social service agencies closed or limited their hours and the number of people they could serve. In addition, the public toilets for washing your hands are closed, and it is almost impossible to maintain social distancing and good hygiene if you survive on the streets with other people in the same situation.
Infections linked to the use of injections have increased because people did not have access to harm reduction supplies, like needles or pipes. Before the pandemic, we did not have adequate harm reduction measures, and we still do not. The pandemic further underscored the urgent need to integrate and deliver harm reduction, as well as to accommodate safe spaces across the continuum of care for people who use drugs, and not just in clinics. like mine or needle exchanges.
If I have patients who inject and are unable to access supplies, their drug use does not stop. They will use and share needles with other people, making them more vulnerable not only to contracting and spreading COVID, but also to other blood-borne infections like hepatitis and HIV.
Patients who took buprenorphine, a life-saving drug for opioid use disorders, had difficulty obtaining their medication. Buprenorphine is a partial opioid agonist drug, which means that it activates the same receptors in the brain as other opioids, but only partially. It prevents and treats painful withdrawal, relieves cravings and prevents death from overdose. Because it restores the altered neural pathways that cause compulsive continuous opioid use, it helps people with opioid abuse disorder regain normal function.
Many patients had difficulty reaching their prescribers when the clinics closed, so we accepted them into our clinic. We were getting calls from the New England area, not just Massachusetts, but places like New Hampshire and Maine. People were like, “I can’t reach my supplier, what should I do? ”
My clinic is a safety net, a low barrier, a walk-in clinic, “come as you are”. Our model took a hit during the COVID peak as we had to follow strict hospital infection control and social distancing measures. We could no longer use our regular walk-in model – we had to socially move away from the waiting room and make sure patients were seen efficiently and discharged from the hospital quickly. They couldn’t spend time with us all day; they couldn’t stay in the clinic while they were coming down from a high pressure area. They contacted the recovery coach or therapist by phone from the clinic. It was very different from the model we were using. We had to switch to a slightly more traditional model.
We were vigilant to stay open every day for in-person and virtual care, especially for those who did not have access to a phone or computer but had to reduce our hours as we also had to look after people in the room. COVID clinics. Other staff worked remotely during the peak.
At first, patients with substance abuse disorders could only be seen in the hospital if they had an appointment. We had to communicate to hospital staff, “These are very high risk patients, many will not have appointments in the system, please let them in. “
When the pandemic hit, I was concerned that pharmacies would run out of buprenorphine, which would put people at risk of opioid withdrawal and reversion. We stocked up on sustained-release buprenorphine every month. If patients could not access their daily oral medications, we were able to provide them in a monthly injection if they wanted. Many patients have found this to be extremely stabilizing, especially those patients who feared losing their prescriptions or having them stolen.
We had glimmers of hope during the pandemic. We have seen the barriers lower to improve access to life-saving medicines, buprenorphine and methadone, by allowing virtual care rather than in-person consultations. The federal government relaxed the regulations to allow methadone clinics to give patients up to 28 days of methadone at a time. Before the pandemic, patients who used methadone had to go to a clinic every day to get their dose with very limited extra doses to take home if they met certain strict requirements.
My I hope the rapid and empathetic mobilization our country has shown in response to the COVID pandemic will translate into the opioid crisis. People have shown they can take action, take care roles outside of their comfort zone, embrace new protocols, and widely disseminate life-saving treatments for people with COVID, a deadly disease. Imagine if we took some of that energy and applied it to the deadliest drug crisis our country has ever seen?
The good news is that we already know what works in beating the opioid overdose crisis. We now need a larger workforce to help us increase access to life-saving medicines that we know work, stay with people when they need us most, and keep them there. security and engaged in a way that balances their competing priorities.