ANALYSIS - Social Isolation, Treatment Disruption During COVID-19 Exacerbated Opioid Crisis In US

MOSCOW (UrduPoint News / Sputnik - 10th December, 2022) The COVID-19 pandemic had a negative effect on the spike in opioid overdose in the United States as people across the country struggled with isolation and the healthcare system had to adjust to provide treatment to drug addicts on time, experts told Sputnik.

The rising usage of opioid drugs, both legal and illegal, has been skyrocketing in the US for decades, due to various reasons. One of them was the rise of highly potent and addictive painkillers, most notably OxyContin, which was liberally prescribed by doctors who believed assurance from pharmaceutical companies that this treatment was safe and effective. At the same time, over the years a number of medical professionals have been convicted for running so-called "pill mills," inappropriately dispensing controlled prescription drugs to people, including habitual drug users.

In addition, some people who may have needed painkiller medication at some point got addicted and continued using. Inevitably, many of them developed a tolerance to pain pills and had to switch to harder opioids like heroin. This created a burgeoning " market" ready to be exploited by various criminals, including Mexican drug cartels who started shifting from marijuana and cocaine to synthetic drugs in the 2000s. As a result, the number of opioid overdose deaths has been steadily growing since the early 2000s, becoming a national health emergency.

Jonathan Caulkins, the H. Guyford Stever professor of operations research and public policy at Carnegie Mellon University's Heinz College, told Sputnik that the main reason behind the increase in overdose deaths was the expansion of illicitly manufactured fentanyl (IMF) in the opioid supply.

"Originally, IMF was mostly used to adulterate or replace heroin, so its users had some tolerance to opioids. The extra surge in deaths of late has happened as suppliers have also mixed IMF into counterfeit pharmaceutical pills � some of which are taken by people without prior exposure to opioids � and also into stimulants, notably meth and cocaine," Caulkins explained, adding that "even long time users of those stimulants would not necessarily have developed tolerance to opioids, so doses that would be fatal to an experience opioid user can be fatal for them."

The coronavirus pandemic and ensuing lockdowns created additional difficulties in an already tough situation. According to the data from the Centers for Disease Control and Prevention (CDC), the overall drug overdose deaths rose by a historic 30% from 2019 to 2020, driven in large part by illicitly manufactured fentanyl. In 2021, overdose deaths were up 15%, passing the 100,000 threshold.

The latest provisional data from the National Center for Health Statistics shows the number of drug overdose deaths for the 12-month period ending in April 2022 increased by almost 7% to 108,174. Meanwhile, the number of opioid-involved drug overdose deaths for the same period increased to 81,692 from the previous year's 76,383.

Caulkins noted that one of the reasons things took a turn for the worse was that some treatment services were shut down during the pandemic.

"Over time, there was adaptation, and greater capacity to provide medication assisted treatment (e.g., methadone) with less requirement for the patient to be in-person," he said, adding that "the healthcare system actually responded pretty quickly in adjusting to those circumstances, but the adjustment wasn't instantaneous, and so at least for a time some people lost access to their treatments."

Caleb Alexander, a professor of epidemiology and medicine at the Johns Hopkins Bloomberg school of Public Health, drew attention to the fact that even prior to the pandemic, the country's treatment infrastructure suffered from widespread shortcomings, adding "the need for treatment expansion, as well as prevention and recovery efforts, has never been greater."

David Frank, a medical sociologist and research scientist at the NYU School of Global Public Health, nevertheless, chided methadone clinics for doing "a poor job responding by being stingy and moralistic with their expanded ability to give take-home doses to people." The expert also suggested that the rising overdose stems from the criminalization of drugs in the US and that the pandemic exacerbated things "by putting all kinds of stressors on people and messing up their connections to drug sellers, forcing them to go to less trusted sources."

"If people had a safe, reliable, regulated way to get their opioids, they would (this is partly why people are increasingly getting on methadone maintenance). But they're stuck with what they're stuck with," he opined.

Another aspect of the pandemic that threw a wrench into the efforts to address the opioid crisis is the fact that many people had to dramatically reduce their social interactions during lockdowns, ending up effectively on their own.

"It is said that addiction is a disease of isolation, and unfortunately, the pandemic has worsened this social isolation for millions of Americans, including many individuals with opioid use disorder," Alexander said.

This social isolation could be especially dangerous to drug users since there is no one to call 911 or administer first aid in case of a medical emergency, as Caulkins explained.

"With COVID, more people spent more time alone, including drug users, so more use sessions happened without someone else present who could respond if there were an overdose," the expert stated.

Meanwhile, as the US continues to combat the spread of drugs, other countries should take notice as there is no guarantee that they will avoid this issue, since, as Caulkins noted, illicitly manufactured fentanyl is much cheaper than heroin, meaning that drug dealers in other places could switch from one to another just as it happened in North America.

"So far as I know it, isn't happening much yet in the Eastern Hemisphere, but it could at some point, so it wouldn't be a bad idea to start preparing for that possibility," he concluded.