COVID-19, Substance Abuse, and Addiction Treatment in the United States

According to a Well Being Trust report, Projected Deaths of Despair of COVID-19, deaths of despair have been on the rise for the last decade. Amid the pandemic, deaths of despair should be seen as the epidemic within the pandemic, similar to the opioid epidemic. The report’s goal was to predict the added deaths of despair created by the pandemic. Across nine different scenarios, deaths of despair ranged from over 27,000 with a quick economic recovery to over 154,000 with a slow economic recovery. Overall, COVID-19 and everything attached to it has significantly strained the economy, American families, and the vulnerable. Per the University of Michigan, the pandemic poses hardships for people with substance use problems.

In 2020, fatal and nonfatal overdoses increased this year compared to 2019. Experts from the University of Michigan believe the pandemic has created several socioeconomic and emotional stressors. Also, the social distancing and feeling of isolation have contributed to a lack of support for those in recovery. Countless addicts across the country are at risk for relapse and overdose and do not have access to proper support. The Addiction Policy Forum found in a recent survey that 34% of respondents reported changes or disruptions in accessing treatment or recovery support services. Also, fourteen percent said they were unable to receive their needed services. Across the nation, approximately 4% of respondents report an overdose has occurred since the pandemic began. Twenty-four percent of survey respondents indicated that their family members’ substance use has changed because of COVID-19, with 20% reporting increased substance use.

COVID-19 and the Substance Use Treatment Industry

The pandemic created significant barriers for addicts and those in recovery to overcome. Drug and alcohol treatment centers across the nation had to adapt to what some called the ‘new normal.’ Finding new ways to help patients became difficult and some treatment centers had to close their doors or reduce services. There are stories across the country of treatment providers adapting and changing how they operate. For example, the Boston-based construction management firm Commodore Builders announced an expansion of its substance use recovery, offering expanded services to those working in the construction industry, which has taken a hit due to COVID-19. The Substance Abuse and Mental Health Services Administration, cited in the article, indicates construction workers have the second-highest rate of substance use of all U.S. professions—the industry has a 17.3% rate of substance use.

Within the state of Pennsylvania, there have been ongoing issues with relapse, overdose, and treatment centers closing. A state official highlighted the state’s drug abuse problem amid the pandemic: the relapses occurring among young people and treatment centers closing. There are hundreds of licensed treatment centers in the state, which include for-profit and non-profit programs. A reason for many of the program’s closing is decreased revenue and fewer people seeking treatment due to the pandemic. Some of the centers in the state have closed due to the pandemic, and overdose deaths in the state continue. Treatment centers in the state of Kentucky continue to provide resources, and some have reported an increase in demand. However, per the Kentucky Office of Drug Control Policy, there was a five percent increase in drug overdose deaths in the state in 2019.

Health officials and treatment providers across the nation have been reporting an increase in drug overdoses and suicides during the COVID-19 pandemic. The Arizona Department of Health Services observed increased deaths due to suicide and drug overdose during the pandemic. Nationally, the Overdose Detection Mapping Application Program reported a 17.59% increase in drug overdoses from March 19th to May 19th. Health officials in other states like Illinois and Washington reported similar problems. During all of this, most rehabilitation programs have had to adapt practices to prevent the spread of COVID-19.

Drug addiction and overdose are one aspect of the problem, but treatment providers have also been seeing an uptick in suicide deaths due to the pandemic. According to the Centers for Disease Control Morbidity and Mortality Weekly Report, approximately 25% of young Americans aged 18-24 seriously consider killing themselves. The American Association of Suicidology, the Crisis Residential Association, and the National Association of Crisis Organization Directors published impact surveys about the COVID-19 pandemic. Crisis providers across the nation said there had been an increase in substance use issues, an increase in relapses of substance use issues, and an increase in the severity of mental health symptoms. Approximately 37% of suicide hotline providers reported being overwhelmed, while 44% reported being overwhelmed by clinical intensity.

The pandemic has significantly impacted the treatment industry, and it is difficult to know how it will recover. However, rehabilitation programs in states like Florida remain open and provide essential services. Addiction and overdose continue to be problematic across the nation, and the increase in substance use appears to be a societal symptom of the pandemic.

The Overdose Epidemic and COVID-19 Pandemic

Before the pandemic, the country was already battling an ongoing epidemic involving opioids. However, when the pandemic struck, those struggling with opioid addiction and those in recovery were left to fend for themselves. As mentioned above, the Overdose Detection Mapping Application Program has increased fatal and nonfatal overdoses. The CDC also reported an increase in overdose deaths. During the pandemic’s beginning, a high percentage of displaced workers lost their health insurance, creating a perfect storm for people struggling with addiction. According to the article ” An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19, people in recovery from opioid addiction are heavily dependent on face-to-face health care delivery.

States scramble to deal with the compounding COVID and opioid epidemic. As mentioned above, the CDC had predicted that over 70,000 people would die from a drug overdose in 2019, and the 2020 numbers are expected to exceed this. The Washington Post published an article that suspected overdoses jumped 18% in March 2020 to 29% in April and 42% in May. According to the National Institute of Health, substance use disorders constituted 10.3% of the total population done in the study—approximately 15.6% of the COVID-19 cases involved people struggling with addiction. People struggling with addiction were at an increased risk of contracting and dying from the virus. Hospitalizations and death rates of COVID-19 patients were all elevated in people with recorded substance use disorders.

Searching for Rehabilitation Post Pandemic and What to Expect

Post pandemic, there has been an increased need for people wanting help for addiction and substance use. However, politicians continue to place barriers in front of everyday Americans, despite many states lifting COVID-19 restrictions. Most states have re-opened the economy, and Americans are returning to work. However, the number of Americans struggling with addiction increased, resulting in problems with prevention and treatment. According to an article titled The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment, the pandemic brought major global challenges to healthcare systems and public health policies.

Someone with a substance use disorder is part of the at-risk population. The article states, “social and economic changes caused by the pandemic, along with traditional difficulties regarding treatment access and adherence—will certainly worsen during this period, aggravating their condition.”

There is an increased need for treatment, but ensuring the rehabilitation center takes the proper precautions is also important. Most rehab centers remained open, yet many had to close their doors or reduce their services. Someone struggling with addiction has a combined risk of overdose and the new coronavirus. Rehabilitation centers are safe and take the necessary precautions to help their patients. Rehab centers are testing patients and adapting the programs to comply with social distancing guidelines while ensuring their facilities have everything needed to treat addiction.

What are Rehabilitation Centers Doing to Mitigate the Problem?

The American Society of Addiction Medicine put forth a guide for addiction treatment clinicians and programs to treat patients with substance use disorders. The document’s purpose was to guide residential addiction treatment programs, outpatient centers, and all other addiction treatment forms. Some of the policies and practices that treatment centers are encouraged to consider. Staff should wear a facemask, along with residents, when not being able to adequately socially distant. If programs cannot isolate or quarantine patients, they should work with local public health authorities. Programs should have clear policies and procedures to address new and current patients.

Screening should also take place per the ASAM guidelines. New patients should be screened over the phone before arrival and should be screened upon arrival. Screening should also be available for current patients and patients and staff returning to the facility. ASAM recommends that every facility develop screening, follow-up, and quarantine procedures for patients, staff, and visitors. The American Society of Addiction Medicine also recommends that treatment providers and physicians use their personal and professional judgment to interpret guidance recommendations and apply them to the circumstances of their patients and practice agreements.

Considering Rehabilitation and Treatment Post-Pandemic

There is no bad time to consider drug and alcohol treatment, and considering the problems worsened during shutdowns, it is essential to treat the addiction before it spirals out of control. For example, according to the 2020 ESO EMS Index: COVID-19 Special Edition, between January 1, 2020, and July 31, 2020, opioid overdose responses jumped 30%. The numbers increased by approximately 41% and 53% in May and June, respectively. COVID-19 should not prevent someone from attending a drug rehabilitation program. Rehabilitation centers follow strict guidelines set forth by the Centers for Disease Control and state and federal health authorities. The Centers for Disease Control also provides information to patients and treatment providers, helping people decide about treatment.

Overall, hospitals and treatment facilities are prioritizing the safety of patients and workers. Despite some facilities having to cut back services, proper care and help are still being provided. Some changes have included reducing treatment program capacity to adhere to social distancing. Virtual care and telehealth are becoming more accessible. Some facilities are also able to offer group therapy programming online. Help is available, and addicts and their families should be considering treatment and pursuing the options they have available.

The Result of a Pandemic and a Substance Use Epidemic

Before the pandemic hit, drug overdose deaths rose and reached close to 71,00 in 2019, per the CDC, as mentioned above. Drug overdosed deaths reached a record high in 2019 and increased by 4.6% from 2018. Fentanyl and other synthetic opioids caused 36,500 of overdose deaths. Federal officials said the COVID-19 pandemic would increase the overdose rate in 2020. Drug overdose deaths increased by 11.4% in 2020. Some states have seen a more drastic increase than others; for example, Kentucky saw a 25% increase in overdose deaths between January and March of 2020. West Virginia reported a 50% increase in emergency calls in May. The Washington Post reported overdose deaths have steadily increased from an 18% jump in March of 2020 compared to March 2019.

The problems with anxiety, grief, isolation, financial worries and changes at home and work have left millions of Americans struggling. Most researchers believe it is too soon to have definitive data on the pandemic’s effects. However, alcohol sales rose by more than 25%, and an analysis of 500,000 urine drug tests showed an increase of 32% for non-prescribed fentanyl, 20% for methamphetamine, and 10% for cocaine from the middle of March through May 2020. Also, suspected drug overdose deaths climbed 18% during that time, and substance use treatment providers note a complete mix of issues among those needing help for addiction. The problems with addiction persist, and the pandemic exacerbated it tremendously.