It’s not just the COVID-19 pandemic that is spiking across huge swathes of the U.S. right now – drug overdose deaths are also increasing – seemingly uncontrollably too – but, because of health resources now firmly aimed towards coronavirus treatment, significantly less is being done to stop this new epidemic of fatal ODs.
In fact, the opioid epidemic, with its huge number of untold overdoses, never went away either – it just got pushed off the headlines.
Now, the personal and tragic stories of fatal relapses from substance addiction, the premature fentanyl-induced deaths of seasoned addicts, and even those who are new to powerful drugs like opioids, heroin and cocaine – these stories just keep coming and coming, and deaths from drug overdoses are now back on the rise across the nation, and here in Arizona too.
“The concerns we have are related to the big challenges people
are facing right now with Covid: isolation and uncertainty resulting
in very high levels of stress.”
ODMAP Data Provides Evidence of the National Spike in Drug Overdoses
Using the latest data collected from the Overdose Detection Mapping Application Program (ODMAP) – a federal initiative that collects information directly from ambulance teams, hospitals, and the police – suspected drug overdoses nationally (thankfully, not all of them fatal) jumped by 18% in March, when compared with last year, 29% in April, and an even more worrying 42% in May.
In particular areas, like Milwaukee County, one of many, dispatch calls for overdoses have increased alarmingly by more than 50% – a hugely significant rise only highlighted by ODMAP and enabling a timely health response from the county.
ODMAP provides near real-time suspected overdose surveillance data to support public safety and health efforts to initiate an immediate response to a sudden increase or spike in overdose cases, whether fatal or not. However, not all states have signed up to the ODMAP initiative, and in those that have, often the coverage doesn’t cover all the counties in that state. Arizona, for example, only has Maricopa and Pima counties contributing to the overdose data coverage.
Clearly, the coronavirus pandemic has had a direct and detrimental effect on those previously being treated for opioid addiction (opioid use disorder or OUD), on those being treated for other use disorders, and on those actively engaged in their own addiction recovery.
Current Overdose Statistics: U.S. & Arizona
In addition to the latest data on suspected drug overdoses provided by ODMAP, further evidence of the spike in deaths from opioids and other substances is starting to come through, now that we’ve passed the middle of the year.
In fact, the last data-based statement provided by the Centers for Disease Control and Prevention (CDC) regarding drug overdoses highlighted a 3% increase for the 12-month period ending in November 2019. As we have seen, the coronavirus has rapidly accelerated this rising trend.
However, there is more data to backup ODMAP’s national statistics for the overdose spike.
For example, the state of Kentucky, hit disproportionately hard by the opioid crisis, estimated it saw a 25% in overdose deaths from January to March. Additionally, Svetla Slavova, co-director of the federally-funded Kentucky HEALing Communities data study, said the number of emergency overdose cases in the first week of April marked the highest on record in the past 2 years.
West Virginia, also hit disproportionately hard, reported 923 overdose-related emergency service calls in May – that’s a huge 50% percent jump compared with the previous year.
What’s Happening in Arizona?
Arizona, unfortunately, does not have enough currently available data to form concrete evidence of a major drug overdose spike within the state. However, the last official government-sourced data in 2018 highlighted Arizona’s continuing higher rate of fatal opioid overdoses when compared with the national average – 15.9 to 14.6 per 100,000 standard population – even though Arizona’s health system wrote less opioid prescriptions than the national average for prescribing such drugs.
Furthermore, like the rest of the country, Arizona reported a near twofold increase in fatal overdoses involving synthetic opioids other than methadone – these were primarily fentanyl. Therefore, when Arizona’s higher-than-average rate of substance abuse is taken into account, it can be safely estimated that the state is undergoing an identical or a similar spike in fatal drug overdoses that ODMAP data has now proven.
Latest Arizona COVID-19 Data
Lastly, when it comes to the latest data on how the coronavirus pandemic has affected Arizona, the news is not good. The Arizona Department of Health Services (ADHS) shows the latest data on its online COVID-19 dashboard, which currently reports 3,653 positive cases as of July 7th., and 117 new deaths in the state. Across the U.S. as a whole, over 3 million cases have now been reported, with more than 130,000 deaths.
Now, with hospitalizations rapidly climbing, in response Arizona became the first state in the nation to trigger “crisis care” standards – a protocol that helps medical staff decide who gets treatment as a priority. At present, around 90% of Arizona’s ICU beds are now occupied, according to ADHS data. Because of this surge, on June 29th., Governor Doug Ducey (Rep.) called a temporary halt to Arizona’s reopening, once again closing bars, theaters, and gyms, and restricting large gatherings.
The Harmful Effects of COVID-19 on Addiction Treatment & Recovery
Nothing comes close to the coronavirus pandemic when it comes to forcing such a drastic impact upon American life – not one citizen has been free from its reach. From personal lockdowns, quarantines, and social isolation, to businesses shutting their doors, “Closed” signs adorning the entrances of universities and high schools, and U.S. states literally closing their own borders and refusing entry to people from other U.S. states.
Currently, COVID-19 is now forcing newly reopened businesses to close once again, hospitals to again consider their emergency treatment protocols – to treat this person, who has a higher likelihood of recovery, compared to this one or not, and pushing the economy further and further into the red, with mass unemployment and bankruptcies the like of which haven’t been seen since “The Great Depression” of the 1930s.
And all with no clear end in sight, bar the unlikely miracle of an early and effective vaccine.
The impact of COVID-19 upon the addiction treatment industry, like so many others, has been colossal and far-reaching. For example, at a national and governmental level, the pandemic has placed a new billion-dollar research program targeting new forms of addiction treatment quite firmly on hold.
Recently, top U.S. health officials, whose normal data collection methods take several months, have reported similar findings to the ODMAP initiative – drug overdose deaths are surging, driven primarily by increased substance use due to anxiety, social isolation and depression, the less obvious impact of the coronavirus. A government drug policy office analysis showed an 11.4% increase this year in drug overdose deaths when compared to the same period – January through April – of last year.
Furthermore, the screening for illegal drugs like fentanyl at national entry points by U.S. Customs and Border Protection officials have also been disrupted by the pandemic, even though drug seizures are still increasing – a huge 57% increase in seizures between March and May of this year, when compared to the same period last year.
Addiction Centers Coming Under Severe Financial Pressure
Just as with virtually all other U.S. industries, the addiction treatment field has suffered similar severe financial pressures as a result of COVID-19. In fact, many rehab centers across the nation (Arizona included) are actually facing financial collapse if things don’t improve soon. Many centers report clients not making their scheduled treatment appointments, and obviously fear this is because of overdoses and relapses, or even the simple fear of coronavirus infection.
With less revenue coming into them, addiction treatment centers have also had to invest in new technology to be able to provide telehealth services, where clients receive counseling and other treatment via their computer screens.
For the non-profit addiction centers, the pandemic has been crippling. Normally operating on extremely tight margins as it is (and also relying on Medicaid and Medicare reimbursements and local government grants), the non-profits have struggled to treat their clients. In a recent survey, 44% of members from the National Council for Behavioral Health say they will easily run out of money in the next 6 months.
All of this echoes the concerns of health experts who predicted that conditions like social isolation and quarantines, accompanied by job losses and uncertainty, would inevitably exacerbate the current opioid crisis, the rates of substance abuse in general, and the number of fatal drug overdoses.
Stressful Isolation: The Ultimate Relapse Trigger
Those in addiction recovery, all across the U.S. and equally here in Arizona, have been one of the demographics hit particularly hard due to the effects of the coronavirus pandemic. Inpatient or outpatient treatment, and then remaining clean and sober after treatment, relies heavily on social human contact (during counselling sessions, support group meetings, fellowship meetings, etc.), and COVID-19 has taken all that away.
The pandemic has resulted in much fear, uncertainty, anxiety, and depression for those most vulnerable, and then promptly cut off the human connections that help ease those burdens:
“So much of addiction has nothing to do with the substance itself.
It has to do with pain or distress or needs that aren’t being met.”
Additionally, the pandemic has resulted in extra and unhealthy stress for anyone hitting the unemployment lines, furloughed or simply concerned about their job security, including those in addiction recovery, or anyone seeking medical treatment and medication for a diagnosed health condition, such as cancer, diabetes, hypertension, and those enrolled in an opioid addiction treatment program, where either the dispensing of naloxone or Vivitrol is involved.
The overall result of these COVID-19-related factors for those in addiction recovery is “stressful isolation” – the ultimate relapse trigger.
The Rise of Telehealth & The Need to Adapt
The consumption of drugs and alcohol has increased across the U.S. during the pandemic, creating an anticipated increased need for addiction treatment in the coming months and years. With the presence of the coronavirus within nearly all communities, the addiction treatment industry is relying more and more on the telehealth services they provide (also known as teletherapy), and that is very likely to continue.
For example, many New York psychiatrists continued to see their clients online, from their own homes to the client’s, while the coronavirus was hitting the city harder than most. One NY psychiatrist, Dr. Philip Muskin, who normally works out of his practice at Columbia University Medical Center, said in an interview, “I’ve been a psychiatrist for more than 40 years; I have never FaceTimed a patient in my entire career!” His normal first encounter would be walking patients to the door, shaking their hand, or touching their arm or shoulder to reassure them. He says, “Now I’m not doing that, and that’s weird to me. So it’s a whole new, very unpleasant world.”
The rise in telehealth has been assisted by many federal and state laws and licensing restrictions concerning privacy being lifted during the course of the pandemic, allowing physicians and therapists to provide care either by phone or online. Furthermore, it was understood by the relevant authorities early on that lockdowns and social isolation would place those in addiction recovery facing unhealthy increases in stress, anxiety, depression, and the pressures of addiction.
Since these services have been in general operation, there have been clear indications that telehealth, teletherapy, telemedicine services and alike do offer certain benefits, such as being:
- Easier to provide
- Cheaper to provide
- More immediate, timely and responsive, and
- Offering an additional level of discretion
Lastly, the success of 12-Step fellowship meetings, like AA, NA, and Al-Anon, moving online, and still being able to provide the vital sense of community that face-to-face meetings previously offered, has shown that if people are willing to adapt to new and different circumstances and the delivery of their care, telehealth is an alternative service that is destined to continue once the pandemic is finally over.
- World Health Organization: https://www.who.int/emergencies/diseases/novel-coronavirus-2019
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/epidemic/index.html
- National Institute on Drug Abuse: https://easyread.drugabuse.gov/content/what-relapse
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/opioids/fentanyl.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/injury/features/prescription-drug-overdose/index.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/data/analysis.html
- National Institute on Drug Abuse: https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/arizona-opioid-involved-deaths-related-harms#:~:text=Drug%2DInvolved%20Overdose%20Deaths&text=The%20age%2Dadjusted%20rate%20declined,20.7%20per%20100%2C000%20standard%20population.&text=The%20decline%20follows%20an%20increasing,70%25%20of%20all%20overdose%20deaths.
- Arizona Department of Health Services: https://www.azdhs.gov/preparedness/epidemiology-disease-control/infectious-disease-epidemiology/covid-19/dashboards/index.php