Trump, who earlier this month rejected the idea that the pandemic was setting back efforts to curb drug abuse, said his administration would remain focused on the issue. At the same time, he’s warned that the cratering economy, which he’s anxious to reopen, could fuel more deaths from drug overdoses and suicides.
“You will see drugs being used like nobody has ever used them before,” he warned. “And people are going to be dying all over the place from drug addiction.”
But the coronavirus response has prompted leading health agencies to postpone some opioid work. The National Institutes of Health has frozen most non-coronavirus related research, which Volkow said meant postponing vital research into drug addiction. That includes a massive $1 billion project studying opioid alternatives and treatment options that the Trump administration rolled out just last fall.
Further, much of the government’s data collection around drug use and overdoses has been put on hold, potentially creating serious gaps in information about the trends in overdose deaths during the pandemic.
”It’s very, very unclear how these people are dying,” Volkow said, adding that there’s “a very urgent need” for that data.
There’s also widespread fear that the coronavirus crisis itself could fuel a new wave of addiction, between the unprecedented surge in unemployment, the deadly devastation from the disease and prolonged periods of isolation forced by social distancing.
“I think a lot of people are coping with drugs and alcohol,” said Devin Reaves, the executive director of the Pennsylvania Harm Reduction Coalition.
Indeed, alcohol sales surged 55 percent in the first week lockdowns accelerated across the country, according to market research firm Nielsen. Meanwhile, the federal mental health hotline fielded nearly nine times as many calls in March compared to a year earlier.
While it will take months to fully understand how the coronavirus outbreak is exacerbating America’s drug abuse crisis, there are already disturbing reports from Ohio, a state that had seen a 22 percent reduction in overdose deaths after years of sharp increases.
In Montgomery County, home to Dayton, there were 37 overdose deaths in March, the highest monthly total in nearly three years. The coroner for Franklin County, which includes Columbus, said Saturday that there had been 12 suspected overdose deaths in 48 hours.
Lynn, a Columbus woman who asked that her last name be withheld to protect her privacy, said a feeling of isolation led her to use heroin recently for the first time in three months.
“The general mood right now is bad,” she said. “We’re bored, we’re not working. It’s definitely making it more likely for people to relapse or to use.”
Mental health and substance abuse counselors have moved quickly to bring their services online since lockdowns took hold. But Lynn said those telehealth options can’t provide the same level of personal support.
The Trump administration has sought to quickly erase longstanding barriers to telehealth. The Substance Abuse and Mental Health Services Agency is encouraging providers to conduct counseling and therapy sessions over the phone or through video chat after federal regulators relaxed privacy rules.
The administration has also tried to make it easier for people to access vital medication, temporarily lifting restrictions to let doctors virtually prescribe controlled substances for medication-assisted treatment. It’s also reducing the need for daily visits to a methadone clinic by allowing people to receive up to 28 days’ worth of medication-assisted treatment.
The historic stimulus package Congress delivered two weeks ago included $425 million to increase mental health and substance use care in communities, but advocates say that falls well short of what’s needed. They’re seeking another $50 billion in the next major rescue bill under discussion to help stabilize community mental health centers and expand the behavioral health workforce to meet an expected spike in demand.
Some addiction experts say coronavirus could prompt some people to newly seek treatment. More casual users, fearful of supply shortages and withdrawal symptoms, may be more willing to try medication-assisted treatments that are considered the gold standard for addressing opioid addiction.
“The opportunity to buy drugs from the illicit market is less, said Brooke Feldman, who manages two outpatient clinics in Philadelphia. “Some folks may say this is the time.”
Addiction recovery groups in the meantime have said they’re trying to manage the blow to in-person services while health officials urge social distancing. Prevention Point, a nonprofit public health organization in one of the Philadelphia neighborhoods hit hardest by the opioid crisis, has shuttered its drop-in center, suspended HIV and hepatitis C screening and closed off its medication-assisted treatment programs to new patients. It’s also scaled back syringe exchange and peer-support programs for people in recovery.
“When you’re doing grab-and-go services, it takes away the ability of staff and participants to connect with each other,” said Jose Benitez, the group’s executive director.
Kacey Byczek of the Harm Reduction Coalition said most nonprofits that work with substance abuse patients don’t have room in their budget for personal protective equipment, which is already in short supply for frontline health workers. Many have reduced their hours to protect staff. While some drug abuse counseling groups have moved online, it’s hard to replicate personal interaction of in-person meetings, Byczek said.
There’s also fear that drugs people are misusing are now more likely to be mixed with fentanyl or other substances as supply chains are disrupted because of coronavirus. That could lead to a spike in overdoses.
“You will be using drugs you don’t normally use, your tolerance may not be as high,” said Michael Kilkenny, executive director of the health department in West Virginia’s Cabell County.
There are also hurdles to dispensing treatment drugs online. Care providers typically must observe patients receiving treatment drugs like methadone or buprenorphine, which themselves are controlled substances.
“Some requirements are waived but how well some of those [treatment] centers are using those tools now is unclear,” Joshua Gordon, who heads the NIH’s mental health agency, told POLITICO.
The pandemic’s effect on drug abuse rates will likely be tied to the scale of economic wreckage from coronavirus, experts said. The last recession coincided with a sharp increase in opioid prescriptions, helping to fuel the drug crisis. Though prescriptions are down since then, the opioid epidemic has shifted to drugs like heroin and fentanyl.
“We had that little blip, 4 percent or 5 percent decrease [in overdose deaths] and there were way too many headlines celebrating,” said Sheila Vakharia, a deputy director at the Drug Policy Alliance. “That tenuous plateau people hoped we were seeing is not going to hold.”