Measures such as physical distancing and stay -at -home orders have been essential to flattening the curve of COVID-19. As the nation enters the sixth month of the pandemic, there is increasing concern about the effect these steps are having on other public health issues, including substance use disorder and mental health conditions. Both the novel coronavirus pandemic and the opioid epidemic are public health emergencies declared under the authority of the U.S. Department of Health and Human Services, but each pose unique challenges as the pandemic meets the epidemic.
There is little doubt COVID-19 is taking a toll on the nation’s mental well-being. A recent Johns Hopkins survey found a more than three-fold increase in psychological distress since the beginning of the pandemic. What is less well known is the effect the pandemic is having on opioid overdose morbidity and mortality. That’s because the United States lacks a national, real-time database to track overdoses or overdose deaths, making it difficult to pinpoint exactly what is happening. We do know, however, that recently reported overdose spikes may reverse the slight decrease in the rate of opioid involved overdose deaths, according to 2018 data released earlier this year by the National Center for Health Statistics (NCHS).
Scattered reports have emerged from Erie County, New York to King County, Washington of spikes in overdoses during COVID-19. Additional areas experiencing spikes are included in a recently released OD-MAP report. It includes overdose reports from selected areas of the country and found overdose submissions to their database up 20% since the United States reported its first coronavirus case in January 2020. The report also includes information from January, before stay-at-home orders were in place, making it difficult to pinpoint the exact circumstances leading to increased overdoses.
There are a number of possible reasons for increased overdoses, and public reports do not always distinguish between overdoses and overdose deaths. Circumstances may include the closure or reduction in syringe services programs, an important source of harm reduction services such as the opioid antidote naloxone and other health care services. A recent survey of syringe services programs in the United States found that 43% had reduced their services in the past few months. Other possible reasons for increased overdoses include an increase in using drugs while being alone, changes in the drug supply, or decreased calls to first responders.
Some health care procedures have been postponed due to stay-at-home orders but delaying or suspending treatment and harm reduction services for mental health conditions and substance use disorders can be life threatening. Recognizing this, both the federal and state governments have responded with regulatory changes to treatment delivery services for substance use and mental health conditions. The Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) swiftly moved to temporarily revise regulations to ensure continuity of care when many other services are disrupted.
The recent regulatory changes made by the DEA and SAMHSA include increased access to telehealth, as well as allowing take-home doses of methadone for people at an earlier stage of treatment. Other revisions included changes to reimbursements for telehealth services by the Centers for Medicare & Medicaid Services. These are just a few of the many revisions made to laws and regulations under the COVID-19 public health emergency.
In April, Congress included additional funding in the CARES Act to meet increased behavioral health concerns in states. This emergency funding has been provided to states and tribal governments through SAMHSA and other agencies such as FEMA. Currently, the Bipartisan Policy Center is building on its 2019 report that tracked federally funded opioid programs in fiscal years 2017 and 2018 by creating a new report that will track the amount of federal funding sent to states in FY 2019. As part of this effort, BPC is also examining how a select number of states are spending the emergency funds appropriated under the federal CARES Act. In response to a request for information, we have found that states are using these funds to expand behavioral health hotlines in Washington, Tennessee, and Louisiana; to increase access to behavioral health care for under or uninsured populations in Washington or, as in the case of Ohio, to build on existing suicide prevention programming.
COVID-19 is exposing the vulnerabilities and fragile nature of our nation’s health care system, including systems that treat both mental health and substance use disorders. It is also exposing existing health care disparities as we see the disproportionate impact COVID-19 is having on communities of color. As we struggle to identify a path forward in the face of this pandemic, real-time, accurate data on overdoses and overdose deaths is essential. These data, along with research on the reasons for overdose spikes, will help guide the nation’s policymakers toward effective solutions to both the pandemic and epidemic.