Addiction treatment has shrunk

COVID- 19 has overshadowed the U.S. opioid crisis, but that doesn't mean opioid addiction has gone away. During the COVID-19 pandemic, the opioid crisis has gotten worse. Drug overdose death rates rose 13% in the first half of 2020. COVID19 threatens to dismantle an already frayed addiction treatment system, creating a crisis on top of a crisis.

The opioid crisis, or, more aptly, the overdose crisis, has plagued the U.S. for two decades. Drug overdose is the leading cause of accidental death, claiming 70,000 American lives each year. Opioids contribute to 130 deaths daily, enough people to fill a commercial airliner.

As a medical sociologist who has researched the opioid crisis for the last decade, I have seen the havoc it has wrought. Here is how I see COVID19 making it worse.

A glimmer of hope, dashed

Overdose deaths increased steadily each year since 1999 until they declined 4.1% in 2018, largely due to fewer deaths involving prescription opioids. Experts suggest that lower opioid prescribing rates, expanded treatment access and increased naloxone access help explain the decline.

That brief downturn gave way to steeply rising overdose death rates in 2019 and 2020 as deaths involving other drugs like cocaine and methamphetamine rose.

Not only are numbers going up, but the drugs that contribute to overdose have changed.

Many overdose deaths involve multiple drugs. Prescription drugs now play a less prominent role than heroin, cocaine and methamphetamine. Synthetic fentanyl – a potent illegal opioid manufactured in labs – poses the biggest threat. It contributes to twice as many overdose deaths as prescription opioids.

Inadequate addiction treatment

The overdose death rate – 20.7 deaths per 100,000 people – comes as no surprise to people familiar with U.S. addiction treatment.

Only 17% of people with addiction get treatment.

And addiction treatment is notoriously fragmented and underfunded. Cordoned off from mainstream health care, the addiction treatment industry receives scant regulation. Quality varies. Only one-third of facilities provide medications for addiction treatment, evidence-based care that reduces overdose risk.

In the face of inadequate addiction treatment, harm reduction strategies are effective. Harm reductionists encourage people who use drugs to use strategies that protect them from overdose, infectious disease and abscesses from sharing or reusing syringes.

Programs that reduce harm include naloxone programs that distribute naloxone throughout communities and syringe services programs that distribute clean syringes to people who inject drugs. These programs, while effective, receive tepid support, largely due to stigma. Naloxone distribution programs and syringe services programs operate on shoestring budgets with limited hours that have only become more restricted during the pandemic.

Clash of the crises

When the COVID- 19 pandemic began, the federal government took measures to lessen the pandemic's impact on the opioid crisis.

The government lowered barriers to medications for addiction treatment by allowing methadone clinics to give patients medication to take home and by allowing physicians to provide buprenorphine, another drug used in recovery, through telemedicine. These measures reduced in-person contact.

But people dealing with the disorder still face challenges. For one, they cannot attend in-person support groups. Social isolation increases the likelihood of drug use and overdose. While figures are not yet available, much anecdotal evidence suggests that coping with the pandemic increases stress and anxiety while disrupting routines that are important for recovery.