As many US jurisdictions have eased pandemic restrictions, new coronavirus cases have been spiking again. At the same time, regions throughout the country are reporting increases in drug overdose deaths and emergencies.
Since late May, all 50 states have eased restrictions, though both their initial orders and their reopening plans vary widely. Seven states recently reported new highs for COVID-19 hospitalizations: Arizona, Arkansas, California, North Carolina, South Carolina, Tennessee and Texas. Although states including Arizona, California, Florida and Texas have now reimposed some restrictions, further harms may already be locked in. Nationally, daily COVID-19 deaths increased on June 23 for the first time in over two weeks. As of June 30, no fewer than 36 states showed an increase of at least 10 percent in their daily average of new cases over the past seven days, according to Johns Hopkins University.
The crisis of drug-involved deaths has continued and worsened throughout the pandemic. Nationally, regionally and locally, public health agencies and other officials are reporting increases in drug-related overdose emergency visits, phone calls and deaths compared to similar periods from 2019.
The national Overdose Detection Mapping Application Program (ODMAP)—a data project launched by the DEA—is one indicator. “Since the first reported case of COVID-19 [in January],” ODMAP states, “suspected overdose submissions display an average increase of 20 percent when compared to the same time-period during the previous year.”
Additionally, in the first quarter of the year, ODMAP “spike alerts,” which are triggered “when ODMAP submissions increase two standard deviations above the mean in the past 24 hours for a particular county and state,” were 191 percent higher than in the first quarter of 2019. ODMAP’s local research suggests that increases vary greatly by location, rather than being spread evenly.
The American Medical Association is also worried by the national overdose picture. “The AMA is greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid-related mortality—particularly from illicitly manufactured fentanyl and fentanyl analogs,” the organization stated on June 18. “More than 30 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder in counties and other areas within the state.”
Among those states, for example, Rhode Island health officials report a roughly 22 percent increase in accidental drug overdose deaths for the first quarter of 2020. Overdose deaths had decreased in the state over the past several years.
Georgia health officials are also noticing a jump in overdose emergency room visits going right back to March. Overdoses have increased by an average of 3 percent each week since then, with larger increases noted for opioids, including heroin and fentanyl.
And in New York City, the Queens and Staten Island district attorneys’ offices are reporting surges in drug overdoses for the first quarter of 2020—though both stress that data is still incomplete.
Much remains to be discovered about the causes of increases, but the coronavirus lockdown and its impacts are widely believed have contributed, for reasons such as: increased loneliness, anxiety and other mental health issues; the increased likelihood of using alone; the disruption of illicit drug supply chains; and cuts to harm reduction services.
While the two imperatives of protecting people from the virus and protecting people who use drugs may seem contradictory in some instances, a new surge in coronavirus cases will certainly hurt people using drugs. People with pre-existing conditions or poor access to healthcare will have direct vulnerability; medical facilities’ being overwhelmed by COVID-19 patients hampers emergency care for victims of overdose; and of course, people using drugs who are homeless or incarcerated will be under particular threat.
It’s possible to take steps that address both crises. The AMA urged governors and state lawmakers to take action now to remove prior authorization requrements and other bureaucratic barriers to people from getting medication for opioid use disorder. The DEA and SAMHSA have already changed their policies to allow doctors to prescribe drugs like buprenorphine without first meeting a patient in-person, as the AMA noted. States should also repeal some restrictions on pain medicine prescribing, the AMA said. It also urged that governments protect and expand harm reduction programs like syringe services
Freeing more people from prisons and jails—as activists throughout the country have been demanding—will also help mitigate the spread of coronavirus for people who use drugs. Similarly, ensuring housing for people living on the streets will both prevent further spread of the virus and likely prevent drug overdoses.
As is often the case, in the context of both the pandemic and the overdose crisis, steps that help the most vulnerable among us will help us all.