The Opioid Epidemic During the COVID-19 Pandemic

The COVID-19 crisis is impacting nearly every aspect of daily life — and for people who struggle with opioid use disorder (OUD), the pandemic presents serious hardship. 40 states are reporting increases in opioid use, including overdose deaths, emergency room visits, and requests for addiction treatment. 1

OUD affects over 2 million people in the United States alone, and opioid misuse often leads to long-term health problems and overdose deaths. 2  During the COVID-19 pandemic, people who struggle with OUD are experiencing difficulty seeking treatment, accessing their regular support systems, and supporting themselves and their families.

While many people may be turning to opioids to cope with COVID-related stress, these overdose deaths are preventable.

The Rise of Opioid use during covid-19

Across the United States, experts and drug safety advocates are seeing increases in opioid use, overdose, and relapse. In particular, drug overdose deaths increased over 11% in the first four months of 2020 alone. 3

Many organizations are witnessing the effects of this trend. Millennium Health, a national laboratory service that processes drug tests for American companies, saw a 32% increase in samples testing positive for fentanyl. 1 In the Baltimore and Washington, D.C. area, overdose prevention advocates saw a nearly 62% increase in overdoses after state governments imposed stay-at-home orders. 4

Stressful life events, like the ones that COVID-19 is causing, are common triggers for drug addiction and relapse. 5 Stay-at-home orders are also preventing patients from seeking treatment and obtaining medication, which can exacerbate existing OUD. Drug use also increases during economic recessions, and the pandemic saw record-high unemployment rates. 6

The bottom line is that people with OUD are facing unique challenges during this time, which may contribute to overdose and death. If you or a loved one are struggling with OUD during COVID-19, seek professional help immediately.

What is Opioid Use Disorder?

Opioids are highly-addictive chemicals that interact with the brain’s receptors to reduce feelings of pain while also causing euphoria, drowsiness, and mental confusion. 7 If someone misuses and becomes dependent on these substances, they can develop an opioid use disorder.

Doctors often recommend prescription opioids, such as OxyContin, Vicodin, and morphine, to patients who suffer from severe pain. Heroin is an illegal opioid, and fentanyl can be both pharmaceutical and illegally-produced.

Not all people who take opioids have OUD. However, if you develop any OUD symptoms while using opioids, it is important to seek help as soon as possible.

Symptoms of Opioid Use Disorder

When you take an opioid, the reward receptors in your brain are triggered. As a result, your brain associates opioid use with positive reinforcement, compelling you to keep using these substances. 8 This dependence is a hallmark symptom of OUD, and is often accompanied by other serious symptoms.

You may have OUD if you experience at least two of the following symptoms within the past year:

Opiod withdrawal symptoms are obvious indicators of OUD, and they can be dangerous to handle alone. You may experience pain, diarrhea, anxiety, vomiting, insomnia, and chills after stopping opioid use for a short period of time. Because these symptoms are so intense, medical supervision is necessary to avoid relapse.

OUD Treatment and Recovery

To treat OUD, you will need to visit a rehabilitation center that treats opioid addiction. Since withdrawal can be dangerous, part of this treatment involves a medically supervised detox. You will receive medication to relieve withdrawal symptoms, and attend a number of treatment programs.
These treatment programs may include:
OUD treatment has three main goals: to help you develop healthier coping strategies and avoid relapse, to treat underlying mental health conditions that may contribute to opioid use, and to connect you with long-term resources and support systems after you leave the program. Attending rehab provides you with the tools you need to achieve sobriety.

Risk Factors for OUD Relapse

Many factors contribute to opioid addiction and relapse, including mental health problems, difficulty coping with withdrawal symptoms, and a desire to alleviate symptoms of mental illness. 9

In particular, stress is a major contributor to addiction relapse. 10

When a person who is in recovery encounters a stressful situation, they will need to utilize their support system and the coping skills they learned during treatment to avoid relapse. If they have not learned these skills or developed these support systems, relapse is likely to occur.

Stressful life events that might trigger relapse include:

Why Is Opioid Use Increasing During the Pandemic?

A number of factors may be contributing to the rise in opioid use during the COVID-19 pandemic: 11, 12

Seeking Opioid Treatment During COVID-19

Opioid use disorder is a volatile condition. Without proper treatment, stress can lead to relapse and serious complications, including overdose, death, and health problems. In addition to increased stress, fears about contracting the virus and restrictions surrounding in-person treatment are making it difficult for OUD patients to access the resources they need.

However, help is still available during the pandemic. You can seek treatment through teletherapy, COVID-compliant group sessions, and more.

Teletherapy Options

Many healthcare providers are offering remote, virtual services during the COVID-19 pandemic. This digital format allows you to safely access telemedicine from the safety of your own home. If you currently see a therapist or another healthcare provider on a regular basis, ask them about your virtual medicine options.

Virtual Group Sessions

Like therapy sessions, many support groups are moving online. These virtual sessions allow you to stay in touch with your peers and hold yourself accountable to sobriety. Attending these meetings and sharing your experiences may also alleviate feelings of stress, fear, and anxiety.

In some areas, support groups may set up in-person sessions that follow COVID-19 public health guidelines. The in-person interaction may be helpful for your mental health, but it is important to stay safe. If your group is offering one of these sessions, make sure that the event honors social distancing protocol, wear a mask, and limit your contact with others around you.

Outpatient and Inpatient Rehabilitation

Both inpatient and outpatient rehabilitation centers are open and operational during COVID-19. However, the treatment center you choose will depend on where you are in your recovery journey, your concerns about virus exposure, and the level of support you need.

During an outpatient program, you will attend the facility daily to receive treatment instead of living there for a period of time. You will attend the same programs that an inpatient center may provide, such as individual and group therapy. Through an outpatient program, you do not have to live in close quarters with strangers and can avoid potential transmission.

However, outpatient programs may not be the best option for you. The level of support in outpatient settings is not as intensive as inpatient facilities, and you may not receive the same level of care. If this is your first time receiving treatment or you are still detoxing from opioids, inpatient care provides necessary around-the-clock care to help you avoid early relapse.

Speak to a mental health professional to determine the best treatment program for your needs.

Self-Care Routines

When you cannot leave home, it is important to keep yourself healthy, active, and well-rested. These self-care routines can help you avoid relapse and naturally reduce stress.

Develop a daily routine that incorporates the following self-care activities:

Sleep at least 7-9 hours each night — sleep deprivation is a source of chronic stress, and can exacerbate existing mental health conditions. 13
Eat a healthy diet rich in fruits, vegetables, and lean or plant-based protein.

Exercise regularly for at least 30 minutes a day. Movement naturally reduces stress and promotes endorphin production, which can alleviate symptoms of depression.14

Take some time to virtually socialize with the people you love. Schedule video calls, plan a game night, and keep in touch as often as possible.

Schedule time for relaxation, meditation, and self-reflection. Take a warm bath, write in a journal, or start up a meditation routine to relax and reduce the impact of stress.

Seek Professional Help for Opioid Use Disorder

While these methods can help improve your mental health during COVID-19, professional treatment is necessary for opioid use disorder. Attending rehab allows you or your loved one to detox safely, relieve unpleasant and potentially dangerous withdrawal symptoms, and develop the skills necessary to avoid relapse.

Many inpatient rehabilitation programs are open and taking preventative measures to protect patients from COVID-19. Outpatient programs are also operational and available across the country, providing greater flexibility for opioid recovery.

If you believe you are struggling with an opioid addiction, you are not alone. Contact a rehabilitation facility near you to find the resources you need to recover.

Resources:

  1. Issue brief: Reports of increases in opioidrelated overdose and other concerns during COVID pandemic. (n.d.). Retrieved from https://www.ama-assn.org/system/files/2020-09/issue-brief-increases-in-opioid-related-overdose.pdf
  2. Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. [Updated 2020 Jun 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553166/#
  3. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
  4. Alter, A., & Yeager, C. (n.d.). COVID-19 Impact on US National Overdose Crisis. Retrieved from http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf
  5. McCabe, S. E., Cranford, J. A., & Boyd, C. J. (2016, December). Stressful Events and Other Predictors of Remission from Drug Dependence in the United States: Longitudinal Results from a National Survey. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5096384/
  6. Nagelhout GE, Hummel K, de Goeij MCM, de Vries H, Kaner E, Lemmens P. How economic recessions and unemployment affect illegal drug use: A systematic realist literature review. Int J Drug Policy. 2017;44:69-83. doi:10.1016/j.drugpo.2017.03.013 https://pubmed.ncbi.nlm.nih.gov/28454010/
  7. NIDA. 2020, July 10. Drugs and the Brain. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/drugs-brain 
  8. Kadam, M., Sinha, A., Nimkar, S., Matcheswalla, Y., & De Sousa, A. (2017). A Comparative Study of Factors Associated with Relapse in Alcohol Dependence and Opioid Dependence. Indian journal of psychological medicine39(5), 627–633. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688890/
  9. Sinha, Rajita. (2007). The role of stress in addiction relapse. Current psychiatry reports. 9. 388-95. 10.1007/s11920-007-0050-6. https://www.researchgate.net/publication/5930103_The_role_of_stress_in_addiction_relapse
  10. Courtney A. Polenick, Brandi Parker Cotton, William C. Bryson & Kira S. Birditt (2019) Loneliness and Illicit Opioid Use Among Methadone Maintenance Treatment Patients, Substance Use & Misuse, 54:13, 2089-2098, DOI: 10.1080/10826084.2019.1628276 https://www.tandfonline.com/doi/abs/10.1080/10826084.2019.1628276
  11. The COVID-19 Pandemic is Fueling the Opioid Crisis! (n.d.). Retrieved from https://tools.niehs.nih.gov/wetp/public/hasl_get_blob.cfm?ID=12121
  12. McEwen, B. S. (2006, September 15). Sleep deprivation as a neurobiologic and physiologic stressor: Allostasis and allostatic load. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0026049506002289
  13. Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC474733/