How COVID-19 Has Affected Substance Abuse

The United States has been the site of significant social and economic fallout during the course of the coronavirus (COVID-19) pandemic, officially declared in March of 2020.

The last year has been marked by high rates of unemployment, stress, economic insecurity, and uncertainty. And for people with mental health and substance use disorders, the consequences of the pandemic have been felt deeply.

As vaccines for people in the United States become more widely available, understanding the impact of the pandemic on substance abuse and treatment remains important for determining the next steps and helping those in need of care.

Here, we have described some of the ways that the coronavirus pandemic has affected the lives of people with substance use disorders over the past year.

Increased Risk For COVID-19

Early on in the pandemic, the National Institutes of Health (NIH) shared concerns of people with substance use disorders being at elevated risk for contracting COVID-19 and experiencing severe symptoms.

In October, the National Institute on Drug Abuse (NIDA) shared the following:

• People with substance use disorders made up 15.6% of COVID-19 patients in U.S. hospitals, according to electronic health record data.
• People with opioid use disorder were 10 times more likely to have COVID-19 compared to those without a recent SUD diagnosis.
• People addicted to or dependent on alcohol, cocaine, and tobacco were also overrepresented in patients who had been hospitalized for COVID-19.

Overall Impact

Many drugs, when misused, are known to have negative effects on the immune system, the lungs, and respiratory health—all of which can make the body more vulnerable to severe symptoms of COVID-19.

Furthermore, disrupted access to harm-reduction services, healthcare, and housing assistance has been another concern for people addicted to drugs or alcohol during COVID-19.

Changes In Drug Supply And Access

Worldwide, the pandemic has disrupted the production and distribution of several common drugs of abuse, including cocaine, heroin, and prescription drugs.

Changes in drug supply and distribution can affect:

• the price of drugs
• the use of certain drugs over others
• where people buy drugs

Overall Impact

In some countries, these disruptions have affected the street price of drugs. Shortages can also prompt people to switch substances—for example, switching from heroin to highly potent synthetic opioids.

Unemployment And Economic Insecurity

During the pandemic, the national unemployment rate in the United States reached the highest level recorded since data collection began in 1948, at 15% unemployment last April.

Millions of people have experienced job loss, cuts in work hours, or have been unable to continue their previous jobs due to concerns about catching COVID-19 or bringing it home to vulnerable loved ones.

Part-time workers, workers without a college degree, and workers in the leisure and hospitality industries have been especially hard-hit, according to data from the Congressional Research Service.

Overall Impact

Losing access to a stable income, employment benefits, and overall economic stability can lead to the use of unsupportive coping mechanisms, like drinking and drug use.

Drugs and alcohol can often be used to numb, avoid confronting painful situations, and to cope with major sources of stress, sadness, or anxiety.

Self-Quarantine And Isolation

Social support is often crucial to the recovery of people with substance use disorders. While an effective precaution, avoiding close proximity to others during the pandemic has disrupted ties to crucial sources of support: friends, family, peer support networks.

Overall Impact

Self-isolation from others can also cause feelings of loneliness, boredom, and depression—all of which are associated with a risk of relapse, and increases in drug and alcohol use among the general population.

In addition, quarantining also makes it more likely that people who live with addiction will use drugs alone—which can have life-threatening consequences.

Opioid overdoses are more likely to be fatal if there’s not someone else present to administer naloxone, an FDA-approved medication capable of reversing an opioid overdose.

Effects On Mental Health

Survey data over the last year has shown concerning effects of the pandemic on the mental health of teens and adults in the United States, including increased anxiety, depression, and thoughts of suicide.

Mental health concerns like depression and anxiety are a risk factor for substance abuse. They can often co-occur together and can exacerbate one another.

From a CDC survey, more than 40 percent of surveyed adults reported symptoms of anxiety, depression, or using substances like alcohol or drugs to cope with pandemic-related stress in June of last year.

Elevated rates of substance use were reported by:

• essential workers
• caregivers
• young adults
• Black and Hispanic adults

Overall Impact

During the pandemic, feelings of grief, loss, and worsened mental health as a result of external factors—like difficulties paying rent or mortgage—may increase the risk of turning to alcohol or drugs.

This is especially true if someone lacks access to affordable mental health and social support services.

Access To Healthcare Services

Reduced access to healthcare services has been a major issue of concern in the delivery of care for people with substance use disorders during the pandemic.

Prior to the pandemic, the National Institutes of Health reported that people with addiction were already marginalized by the healthcare system, in part due to stigma, which can make a person less likely to seek out care.

Access To Medication-Assisted Treatment

During the pandemic, people with substance use disorders have faced unique concerns, such as evaluating the safety of visiting methadone clinics for opioid addiction treatment.

Last March, the federal government eased regulations on prescribing take-home medications for opioid use disorder to reduce in-person contact, and expanded telemedicine for the delivery of some addiction treatment services.

Overall Impact

For some, these policy changes have reduced some barriers to treatment seen prior to the pandemic, such as difficulty finding transportation and time constraints.

For others, issues such as lacking health insurance and having the technology needed to access telemedicine continue to restrict or complicate access to care.

Surge In Drug Overdose Deaths

Although complete data isn’t yet available, a December health alert from the CDC reported that 2020 is on track to be the deadliest year for U.S. drug overdose deaths in recorded history.

Drug overdose, which occurs when someone takes too much of one or more drugs at once, is not always life-threatening but can become so in severe cases and without immediate treatment.

Risk factors for overdose include:

• using drugs alone
• taking illicit drugs
• injecting drugs
• taking opioids with benzodiazepines, alcohol, or psychostimulants
• taking high doses of drugs following detox

From June 2019 to May 2020, the CDC reported that more than 81,000 people in the United States had died of a drug overdose, with most involving synthetic opioids like fentanyl.

Overall Impact

The largest spike in overdose deaths occurred from March to May of 2020, as communities nationwide grappled with high unemployment rates, school closures, and reduced social support.

According to the American Medical Association, more than 40 states have reported elevated rates of opioid overdose deaths since the pandemic began.

Support Groups Moving Online

Many counselors, psychiatrists, and primary care doctors have made their services available by phone or video call, in order to reduce the risk of spreading the coronavirus.

Many support groups, such as Alcoholics Anonymous (AA), also moved their groups online to comply with social distancing guidelines and reduce risks associated with meeting in-person.

Virtual support options include:

• Alcoholics Anonymous (AA) groups
• Narcotics Anonymous (NA) meetings
• We Connect Recovery Groups
• Cocaine Anonymous groups
• 12-Step Online
• In These Rooms
• Recovery Dharma
• Sober Recovery forum

Overall Impact

Unfortunately, this move from in-person to online meetings has likely posed a barrier for people who lack steady access to WIFI, or who do not have access to a computer for meetings.

Even still, online support groups and forums for mental health, substance abuse, and grief have become an essential source of support for people who have been struggling during the pandemic.

Harm Reduction Practices

During the pandemic, the practice of sharing needles, syringes, and other drug paraphernalia has been an ongoing issue of concern, particularly among homeless populations addicted to drugs.

The national Harm Reduction Coalition has developed several resources with recommendations to help curb the risks of spreading COVID-19 and fatal overdose.

Harm Reduction For Preventing Fatal Overdose

More than 120 people die of a fatal drug overdose every day in the United States. The risk of fatal overdose can be reduced by utilizing some harm-reduction practices.

Recommendations for preventing a fatal overdose include:

• keeping a steady supply of naloxone
• asking a trusted person to check-in with you at specific times if you plan on using drugs alone
• avoid mixing drugs or taking high doses
• avoid injecting drugs when possible, and consider alternatives routes
• checking drugs for fentanyl with fentanyl testing strips

Harm Reduction For Hygiene And Cleanliness

If you aren’t using drugs alone, it’s recommended that you practice social distancing guidelines to the best of your ability and to use precautions when it comes to close contact with others.

Harm-reduction advocates recommend that you:

• avoid sharing needles, syringes, straws, lighters, or other paraphernalia
• if sharing, wipe down paraphernalia (e.g. mouth-pieces) with alcohol swabs before and after use
• wash your hands for at least 20 seconds after coming in contact with other people
• wipe down all surfaces where you prepare drugs before and after use, with bleach, alcohol, or antimicrobial wipes
• try to minimize close contact with others
• avoid others if you are feeling sick

Harm Reduction For Staying Well

Taking care of yourself physically and mentally is important and can reduce some health risks associated with drug use, such as overvamping and unsafe sexual activity.

Recommendations include:

• avoid extended sleep deprivation
• stay hydrated by drinking water
• eat regularly
• keep a stocked supply of first aid and wound care supplies
• prepare for an elevated libido

Are Addiction Treatment Centers Open During COVID-19?

While some treatment centers have closed their doors during COVID-19, many rehab centers have adapted, by implementing recommended safety guidelines and moving some treatment services online to remain open during the pandemic.

There are a wide range of treatment programs for substance abuse at multiple levels of care, which can vary in their intensity, programming, cost, and level of support provided.

Treatment programs for substance abuse include:

• inpatient rehab programs
• residential treatment programs
• outpatient treatment programs (PHP, IOP, OP)
• outpatient counseling services
• medication-assisted treatment (MAT)

People who are actively abusing alcohol or drugs, or struggle with chronic addiction, may require the level of support and structure offered within an inpatient treatment program.

For mild substance abuse, or for people who lack the means to access inpatient care, outpatient treatment may also be helpful. This can be more flexible and cost-effective for people who don’t require 24-hour supervision.

Resources For Those With An Addiction Affected By COVID-19

Rising rates of substance misuse and fatal overdoses during the pandemic are ongoing issues of concern among health professionals, and individuals and families affected by addiction.

For those affected, a number of resources have been developed to help guide those affected during the pandemic, with information on how to find treatment, coping skills, and lists of virtual support options.

Treatment locators:

• Substance Abuse and Mental Health Services Administration (SAMHSA): Find Treatment
• NIAAA: Alcohol Treatment Navigator

Substance abuse and addiction resource guides:

• The CDC: COVID-19 Questions and Answers for People Who Use Drugs or Have Substance Use Disorder
• National Harm Reduction Coalition: COVID-19 Guidance for People Who Use Drugs and Harm Reduction Programs
• National Alliance on Mental Illness (NAMI): COVID-19 Resource and Information Guide

You can keep up-to-date on the latest information surrounding COVID-19 and substance abuse by checking the websites of the CDC, the National Institute on Drug Abuse, and SAMHSA.

Written by the Addiction Resource Editorial Staff