When a Pandemic Meets an Epidemic: The Opioid Crisis during COVID-19.

In the last year, the COVID-19 pandemic has collided with the opioid epidemic creating an influx of relapses, overdoses, and deaths. Over 20 million people in the United States have a substance use disorder. As of September 2020, thirty states reported an increase in opioid fatalities since the pandemic started in early 2020. While the overwhelming presence of anxiety, grief, and depression caused by or exacerbated by the pandemic significantly contributed to these numbers, the ongoing isolation continues to prevent individuals suffering from addiction from accessing support systems, hospitals, treatment centers, and other sources of help. Whether it is the fear of contracting the virus from a physician’s office or not having anyone nearby to recognize a dangerous situation, the pandemic has become a severe impediment to the opioid crisis. Luckily, American health organizations are increasingly aware of this rise in substance use disorder and are acting.

In July 2020, the FDA took necessary steps to make naloxone, a medication that can help reverse opioid overdose to prevent death, accessible to the community. To do this, the FDA required opioid manufactures to update package inserts to include recommendations about naloxone and its benefits. This recommendation encourages providers to discuss naloxone with all patients when starting or renewing an opioid treatment. It also urges providers to assess each patient’s need for a naloxone prescription. The FDA plans to implement these changes early this year.

Following agency action, in December 2020, the American Medical Association (AMA) provided recommendations to help states and policymakers support patients with opioid use disorder during the pandemic. These recommendations include ensuring access to care for patients with an opioid use disorder, protecting patients with pain, and utilizing harm reduction efforts to better prevent overdose and the spread of infectious disease. As a result, states like Washington, New Jersey, and Ohio are utilizing curbside and doorstep deliveries of methadone and buprenorphine for quarantined or isolated individuals because of COVID-19 and those in the at-risk population. Additionally, organizations like the American Academy of Physical Medical & Rehabilitation provided COVID-19 specific recommendations and considerations for physicians treating patients with chronic pain.

Increased state and agency responses also influenced the federal government to take action for patients suffering from substance use disorder. In January 2021, the Department of Health and Human Services issued a decision to allow physicians to “prescribe without a waiver highly effective medication for the treatment of patients with opioid use disorder.” This decision allows physicians to work with patients and provide care without worrying about authorization barriers and a strict regulatory regime. This cancellation of the waiver requirement effectively reduces the detrimental stigma and health disparities in accessing treatment. It nevertheless is important to acknowledge the systemic racial and socioeconomic inequities that still plague America’s health care system.

The repercussions of the collision between the opioid epidemic and the COVID-19 pandemic are only starting to show. The increased need for addiction treatment combined with the decreased access to treatment options presents a detrimental problem in the United States. Policy and lawmakers must continue to analyze and reevaluate how organizations delivery health care to its stakeholders, including adapting to the use of telehealth and continuing the use of regulatory waivers. People with substance use disorder should not have to battle addiction alone during and after the pandemic.