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By James Poccia, JHBL Staff Member
Before COVID-19 took the nation by storm in early 2020, the opioid epidemic was the biggest health concern in the United States. But since the first case of COVID-19 was confirmed in the United States, it has been the subject of the country’s undivided attention as it halted everyone’s day-to-day lives. Meanwhile, the opioid crisis “quietly” found renewed life in the midst of the overriding COVID-19 pandemic. Significant progress had been made in combatting the opioid epidemic through the past few years. For example, there was actually a decrease in opioid-related drug deaths in 2018 for the first time since 1990.[1] Despite such positive strides, many believe that COVID-19 threatens to erase that progress if measures are not taken to address the underlying opioid health crisis.[2]
Since the COVID-19 pandemic first took hold of the United States, opioid-related deaths have been projected to increase drastically. While it may be too soon to accurately collect data on the pandemic’s effect on opioid overdoses, preliminary numbers have been shocking. Since the pandemic began, over 40 states have reported significant increases in opioid-related deaths.[3] A University of Baltimore national tracking system reported that drug overdoses increased 18% after stay-at-home orders went into effect.[4] A Washington Post report found that suspected overdoses nationally rose 18% in March, 29% in April, and a staggering 42% in May, compared to the same months in 2019.[5] The director of the National Institute on Drug Abuse, Dr. Nora Volkow, even predicted that overdoses may have increased as much as 30% to 40% during the pandemic.[6] No matter what the data says at the end of the day, the trends are unequivocally indicating that COVID-19 has coincided with an unprecedented exacerbation of the opioid epidemic.
So how is it that COVID-19 could be responsible for such an astronomical surge in opioid overdoses? Most experts are pointing to the pandemic’s collateral effects for answers. For example, stay-at-home orders have caused intense feelings of anxiety, stress, and isolation in individuals, which are common triggers for substance use.[7] Isolation from others has also made drug overdoses even deadlier because there may not be anyone present to call 911 or administer naloxone (also known by the brand name, Narcan) in the event that someone overdoses.[8] Further, Dr. Charles Reznikoff claims that gaps in the opioid supply chain may be contributing to deadlier overdoses because users may not be able to use as frequently or may be unaware of a new drug’s potency, indicating any variation in drug-consuming behavior can be deadly.[9] Record unemployment also means that many people have lost their jobs, which not only fuels stress-induced substance abuse but also means the loss of their employer-sponsored healthcare that provides opioid users with access to the medical care they need to fight their addiction.[10]
The pandemic also precluded access to care in a number of ways, in addition to the loss of job-related healthcare. Methadone clinics had to limit capacity or shut down entirely at the beginning of the pandemic because staff and patients were transmitting the virus in close proximity to one another.[11] Coronavirus-induced hospital overcrowding meant that hospitals had to turn away some substance users who needed medical treatment.[12] Even when providers admitted patients, many individuals were simply too scared to seek treatment for fear of contracting COVID-19.[13] Access to pharmacological treatments for opioid addictions also faced a legal hurdle when in-person treatment was suspended because the Controlled Substances Act limits practitioners’ ability to prescribe controlled substances over the internet.[14] Even substance user support systems, such as Narcotics Anonymous and syringe-exchange programs, became less accessible once shut-downs went into effect.[15]
Fortunately, some of these aggravating circumstances have subsequently been addressed. Many Narcotics Anonymous groups started to conduct meetings online to continue providing substance users with support systems virtually.[16] The Drug Enforcement Administration issued guidance to medical practitioners that allows them to circumvent the Controlled Substances Act by prescribing opioid addiction treatment medications via telemedicine.[17] Despite the value of these positive steps, they are limited in their success. For example, Dr. Volkow indicated that virtual services are limited in their reach because not everybody has access to the internet or a cell phone. She points out that those people are often the ones who need access to support systems the most.[18]
The Coronavirus Aid, Relief, and Economic Security (CARES) Act has similarly been criticized for failing to adequately address the impact of COVID-19 on the opioid epidemic. Out of the $2 trillion that was dispersed by the CARES Act, $450 million was appropriated for mental health providers, which included only $100 million that was explicitly granted for substance use disorder resources, comprising less than .02% of federal COVID-19 response funding.[19] As overdose deaths continue to climb to unprecedented heights because of the pandemic, it can safely be said that the CARES Act failed to provide a sufficient response to the virus’ grave consequences to the opioid crisis.
If the mitigating measures taken thus far have been inadequate, what will it take to effectively combat the worsening opioid epidemic while the coronavirus continues to wreak havoc on the country? Senator Elizabeth Warren has offered one potential solution to the quandary. In an op-ed recently published in the Dorchester Reporter, Senator Warren advocated for the passage of the Comprehensive Addiction Resources Emergency (CARE) Act, which specifically aims to combat the opioid epidemic in local communities. The bill, originally introduced by Senator Warren and the late Representative Elijah Cummings, intends to appropriate $100 billion over a ten-year period for the specific purpose of equipping states and municipalities to effectively fight the opioid epidemic.[20] Additionally, the bill provides $800 million per year to Native American nations and organizations that are particularly hard-hit by the epidemic, funds research initiatives spearheaded by the National Institutes of Health and Centers for Disease Control and Prevention, and aims to hold pharmaceutical companies liable for their role in perpetuating the opioid epidemic.[21] Enacting legislation such as Senator Warren’s CARE Act would be a significant step forward in the fight to provide a comprehensive solution to the opioid epidemic, especially in the midst of COVID-19.
Furthermore, the American Medical Association has published a comprehensive list of recommendations to help the healthcare community navigate through the opioid epidemic in the age of COVID-19. Their first priority is to ensure access to care for opioid use patients during the pandemic by making it easier to get necessary medications and preventing lapses in insurance coverage for certain medications.[22] They further recommend that integral treatment programs, such as syringe programs, be given the necessary funds and equipment to continue to operate safely and effectively throughout the COVID-19 pandemic.[23] In order to have any true effect, these recommendations must be adopted by policymakers on the state and local levels. While many jurisdictions have already implemented these measures at the American Medical Association’s behest, it is essential to promulgate them uniformly throughout the country in order to make the strongest impact.
It is absolutely vital that policymakers enact Senator Warren’s proposed CARE Act federally and implement the American Medical Association’s recommendations on the state and local level in order to manifest a comprehensive response to the emerging “syndemic” of opioid use and COVID-19. A dual approach of federal funding and regulations, in conjunction with state and local measures that ensure safe and effective access to treatment would be a comprehensive framework that would enable the United States to effectively combat the opioid epidemic in the midst of COVID-19. Therefore, it is vital that policymakers adopt the CARE Act and the American Medical Association’s recommendations to put a stop to the surging opioid crisis.
If you or a family member is in need of substance use treatment, call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national helpline at 1-800-622-4357 or visit https://www.findtreatment.gov for treatment referrals and information.
James Poccia is a second-year law student at Suffolk University Law School who is interested in corporate law. James is currently writing a note about Medicaid’s financial impact on states for the Journal of Health and Biomedical Law.
Disclaimer: The views expressed in this blog are the views of the author alone and do not represent the views of JHBL or Suffolk University Law School.
Sources:
[1] Jon Kamp & Arian Campo-Flores, The Opioid Crisis, Already Serious, Has Intensified During Coronavirus Pandemic, Wall St. J. (Sep. 8, 2020), https://www.wsj.com/articles/the-opioid-crisis-already-serious-has-intensified-during-coronavirus-pandemic-11599557401.
[2] David Wedge, Epidemics at Odds: Preventing the Next Wave of the Opioid Crisis During COVID-19, Bos. Med. Ctr. (Mar. 23, 2020), https://www.bmc.org/healthcity/population-health/preventing-next-wave-opioid-crisis-during-covid-19.
[3] Reports of Increases in Opioid- and Other Drug-related Overdose and Other Concerns during COVID Pandemic, Am. Med. Ass’n (October 31, 2020), https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf.
[4] Stacy Weiner, COVID-19 and the Opioid Crisis: When a Pandemic and an Epidemic Collide, Ass’n of Am. Med. Colls. (July 27, 2020), https://www.aamc.org/news-insights/covid-19-and-opioid-crisis-when-pandemic-and-epidemic-collide.
[5] William Wan & Heather Long, ‘Cries for Help’: Drug Overdoses Are Soaring During the Coronavirus Pandemic, Wash. Post (July 1, 2020), https://www.washingtonpost.com/health/2020/07/01/coronavirus-drug-overdose/.
[6] Jeremy Hobson & Samantha Raphelson, Coronavirus Pandemic Compounds Another Ongoing Crisis: The Opioid Epidemic, WBUR (July 7, 2020), https://www.wbur.org/hereandnow/2020/07/07/coronavirus-opioid-abuse-crisis.
[7] Id.; Misha Gajewski, States Scramble to Deal with the Compounding Covid and Opioid Epidemic, Forbes (July 29, 2020), https://www.forbes.com/sites/mishagajewski/2020/07/29/states-scramble-to-deal-with-the-compounding-covid-and-opioid-epidemic/?sh=1712566f7f56.
[8] COVID-19 and the Opioid Crisis, supra note 4.
[9] Id.
[10] Gajewski, supra note 7.
[11] Effects of COVID-19 on the Opioid Crisis: Francis Collins with Nora Volkow, Nat’l Inst. on Drug Abuse (July 6, 2020), https://www.drugabuse.gov/videos/effects-covid-19-opioid-crisis-francis-collins-nora-volkow.
[12] Hobson, supra note 6.
[13] Aaron Weiner, An Epidemic During a Pandemic, Nat’l Safety Council (Aug. 10, 2020), https://www.nsc.org/safety-first-blog/an-epidemic-during-a-pandemic.
[14] Wan, supra note 5; Thomas Prevoznik, Drug Enf’t Admin. (Mar. 31, 2020), https://www.deadiversion.usdoj.gov/GDP/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf.
[15] Effects of COVID-19, supra note 11.
[16] Id.
[17] Prevoznik, supra note 14.
[18] Hobson, supra note 6.
[19] The Stress of 2020 Is Turning the Opioid Crisis into a Disaster, Orlando Sentinel (Nov. 6, 2020), https://www.orlandosentinel.com/opinion/editorials/os-op-opioid-crisis-pandemic-editorial-20201106-r6wdyo3uyvb35lucnqxo3rkqq4-story.html; Coronavirus Stimulus Package Includes Advances for Addiction, Shatterproof (Mar. 27, 2020), https://www.shatterproof.org/blog/coronavirus-stimulus-package-includes-advances-addiction.
[20] Elizabeth Warren, Opioid Epidemic Did Not Pause for Covid; We Must Act to Save Lives, Dorchester Rep. (Oct. 1, 2020), https://www.dotnews.com/2020/opioid-epidemic-did-not-pause-covid-we-must-act-save-lives.
[21] Id.
[22] COVID-19 Policy Recommendations for OUD, Pain, Harm Reduction, Am. Med. Ass’n (Nov. 2, 2020), https://www.ama-assn.org/delivering-care/public-health/covid-19-policy-recommendations-oud-pain-harm-reduction.
[23] Id.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138334/pdf/aim-olf-M201212.pdf
https://tools.niehs.nih.gov/wetp/public/hasl_get_blob.cfm?ID=12121