COVID poses hardships for people with substance abuse problems

Faculty Q&A

Both fatal and nonfatal overdoses have increased this year compared to last, according to a recent report by the Overdose Data Mapping Application Program. And, anecdotal information suggests that compared to last year, people in recovery are relapsing at alarming rates.

Faculty from the University of Michigan School of Nursing’s Center for the Study of Drugs, Alcohol, Smoking and Health discuss why the pandemic has hit people with substance abuse problems especially hard and the expanded role of virtual recovery programs.

Are overdoses and fatal overdoses increasing, and why?

Carol Boyd, professor emerita and DASH co-director: Since the coronavirus pandemic began in February, we have feared that the opioid crisis would get worse. And data indicate our worst fears have come true. When we compare U.S. overdose data in pre-COVID January-April 2019 to the same period in 2020, there has been an average 20% increase. And in April 2020, the overdose spike almost doubled from the previous year. These data are truly disheartening because the U.S. overdose rate was starting to trend downward.

COVID has created several socioeconomic and emotional stressors while social distancing has contributed to feelings of isolation and has contributed to a lack of support for many individuals in recovery. I believe this has led to increases in opioid overdoses with devastating consequences. For those at risk for relapse and overdose, family members should have lifesaving resources such as naloxone available at home.

Gina Dahlem, clinical associate professor and naloxone expert and trainer: What we have seen in Michigan and nationally is that people delayed seeking emergent care for non-COVID reasons. This has also been true for overdoses. Locally, we are seeing lower numbers of emergency department admissions for opioid-related poisonings, but higher opioid-related deaths as compared to the same time period in 2019. Also, due to COVID, naloxone distribution has decreased. Finally, with people delaying care, these reasons may have contributed to increased deaths.

Terri Voepel-Lewis, associate professor who researches youth and risky prescription opiate decisions: The pandemic has not only negatively impacted mental health, but has also affected the ability (and likely the desire) of people to seek routine health care. Given stay-at-home orders and fears of going to the doctor or emergency room, people may have become more likely to self-treat problems like pain or anxiety with borrowed prescription medication or illicit drugs.

Additionally, people who have sought care for symptom management may have received telehealth visits instead of face-to-face care. The DEA approved a new provider ability to prescribe scheduled medications (like opioids) during telehealth visits. While this may be beneficial for many patients, it may be very risky for some––and may lessen the ability to assess for patient risk factors and to educate patients on the risks of addictive medications.

Why is isolation and social distancing so dangerous for people in recovery or for people who overuse alcohol or drugs?

Sean Esteban McCabe, professor and DASH co-director: COVID represents the perfect storm for relapse and substance-related problems. COVID has increased stress for many people in recovery, due to job loss or working full-time from home with no child care, decreased responsibilities, disrupted sleep routines and decreased face-to-face social support. There is an expression in the recovery community: “Stay in the middle of the herd, where you’re less likely to be picked off.” COVID has made it harder for some people to stay in the middle of their recovery herd.

What happens to people released from jail who need treatment or people who need halfway housing?

Dahlem: Studies have shown that people who are released from jail are at increased risk of an opioid overdose due to a loss of tolerance. In fact, this is one of the reasons why it is so important for people who are being released from jails to be equipped with and trained on how to use naloxone.

McCabe: Substance use treatment is still being offered for those in need of treatment, as is halfway housing, but the reduction in face-to-face social support has made it more challenging for people to get connected to the help that they need. Prior to COVID, only one in four people struggling with addiction sought treatment for their substance use disorder. Finding help and support during COVID has become more challenging for the highest-risk people such as the homeless, parolees and those leaving substance use treatment.

However, this is not always the case and some people are finding new ways to find recovery communities. For example, I know a man who is currently in substance abuse treatment and looking for a community to relocate to after treatment. He’s joined online meetings in the cities he’s considering, so he’ll have a support network there when he arrives. He’s considering multiple options and weighing locations that will best support him while staying close to his children and job opportunities. This would not have happened before COVID.

How has COVID changed substance abuse treatment?

McCabe: One advantage to COVID is that it forced health professionals to adapt and provide more telehealth assessment, counseling and treatment. Some organizations already provided this service but many others have had to pivot to offer these services due to COVID. This has opened new opportunities that were not available prior to COVID. The online recovery community has grown tremendously during COVID and will continue when restrictions lift, which should provide more options for support meetings for high-risk people who cannot attend face-to-face support meetings due to health or other reasons.

I can envision more opportunities for precision medicine and opportunities to tailor substance use treatment with all the resources that will be available via telehealth to match the right treatment delivered by the right person at the right time. This is also applicable to long-term recovery. For example, I am aware of one recovery group that had a long-time member move away a few years ago and the members have been able to reunite with him via online meetings. This would not have been possible prior to COVID. We must learn from COVID to improve our batting average for getting people help they need, because our batting average was not good enough to keep us on any team roster before COVID.

How can we support people who overuse drugs or alcohol?

McCabe: If someone you live with is drinking or using drugs too much, bring it up in a nonjudgmental way from the perspective of health and love, and suggest resources for getting help. Students can encourage peers to seek free counseling at Counseling and Psychological Services or get connected to other students in recovery from alcohol and other drugs through the U-M Collegiate Recovery Program. Also, seek resources for yourself. COVID also provides an excellent opportunity to have conversations with your kids and loved ones about their relationship with substances.

Substance use disorders impact the entire family, and there are resources available to family members and children who need support. Sometimes people live with loved ones who refuse to get help for their substance use. This is definitely the case during COVID when so many families are sheltering in place. There are programs designed to help people in these situations take care of themselves whether their loved one stops using or not. There are online support groups, and health professionals are finding new ways to support families during COVID.