Substance use disorders (SUDs) are characterized by the repetitive use of alcohol or drugs that results in either addiction or impairment of normal functioning. According to the National Survey on Drug Use and Health, in the 5 years leading up to COVID-19, prevalence rates of SUDs hovered at around 9% of the American adult population. During that time, an estimated 69% of adults with an SUD suffered from an alcohol use disorder, 20% suffered from an illicit drug disorder and 11% from both alcohol and illicit drug disorders.1 The most recent nationwide analysis by the CDC determined that, from 2017 to 2018, the total number of deaths due to all types drug overdose were in decline, with 4% fewer total deaths recorded in 2018 than in 2017. Although the CDC also determined that deaths specifically due to synthetic narcotics (ex. fentanyl and tramadol) increased by 10% in the same time frame, this 10% increase actually represents a significant improvement on the trend in deaths due to synthetic narcotics observed in the previous 5 years.2,3
However, this progress in decreasing the prevalence of SUDs and SUD-related deaths is threatened by the COVID-19 pandemic. It is the opinion of multiple authorities that 2020 will see a significant increase in the prevalence of substance use, SUDs and substance use-related deaths.5,8 Preliminary data, obtained by the National Center for Health Statistics (NCHS), found that rates of substance use and various comorbid mental health disorders have increased aggressively since the beginning of the pandemic. The NCHS utilized survey data, collected in June 2020, to approximate that 10% of American adults started or increased substance use as a result of peritraumatic stress caused by COVID-19.5,6 It should be noted that the prevalence of substance use as a coping mechanism was found to be far higher in younger demographics, with 24.7% of adults aged 18-25 and 19.5% of adults aged 25-44 reporting that they “started or increased substance use to cope with pandemic-related stress or emotions”.4,5
The most likely reason for this alarming trend is the significant increase in adverse mental health conditions among Americans.4 A longitudinal analysis, conducted by the CDC using the PHQ-4 survey, found that the prevalence of symptoms of anxiety disorder and depressive disorder increased by 210% and 270%, respectively, in comparison with reports from the second quarter of 2019.7 This sharp increase in mental health disorders and in substance abuse is likely linked to social isolation, financial burden, reduced access to psychiatric assistance from health professionals, and intense concern regarding the mortality rates of COVID-19.4,8,9
Furthermore, in addition to the inherent risks associated with increased substance use and abuse, public health experts are concerned that COVID-19 may generate additional complications and increase barriers to treatment for those suffering from SUDs. Three specific issues are of particular concern. First, social isolation measures will likely limit the ability of SUD patients to visit detoxification centers and access legal opioid substitution treatments such as methadone and buprenorphine.10 Secondly, social distancing may also increase the probability of fatal overdoses, as both health services and social support systems are spread thin. Finally, due to the decrease in worldwide drug trafficking and the subsequent reduction in the availability of conventional illicit substances, many SUD patients may turn to new synthetic opioids, benzodiazepines and counterfeit pharmaceuticals that carry an exceedingly high risk of addiction and overdose.11,12
Undoubtedly, recent evidence suggests that there is a second epidemic of mental health and substance use disorders occurring concurrently with COVID-19. This nationwide health crisis requires the immediate attention of policymakers and healthcare providers who must take action to reinforce addiction and substance abuse healthcare in order to prevent negative patient outcomes.13
- Van Horn SL, Lipari RN. “Trends In Substance Use Disorders Among Adults Aged 18 Or Older.” Substance Abuse and Health Services Administration, 29 June 2017.
- “New Data Show Significant Changes in Drug Overdose Deaths | CDC Online Newsroom | CDC.” www.cdc.gov, 19 Mar. 2020, www.cdc.gov/media/releases/2020/p0318-data-show-changes-overdose-deaths.html.
- National Institute on Drug Abuse. “Overdose Death Rates.” National Institute on Drug Abuse, 10 Mar. 2020, www.drugabuse.gov/drug-topics/trends-statistics/overdose-death-rates.
- Czeisler MÉ. “Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic — United States, June 24–30, 2020.” MMWR. Morbidity and Mortality Weekly Report, vol. 69, 2020, www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm.
- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics; 2020. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm.
- Horesh D, Brown AD. Traumatic stress in the age of COVID-19: call to close critical gaps and adapt to new realities. Psychol Trauma. (2020) 12:331–5. https://doi.org/10.1037/tra0000592.
- CDC, National Center for Health Statistics. Early release of selected mental health estimates based on data from the January–June 2019 National Health Interview Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics. 2020. https://www. cdc.gov/nchs/data/nhis/earlyrelease/ERmentalhealth-508.pdf.
- Zaami S, Marinelli E and Varì MR. New Trends of Substance Abuse During COVID-19 Pandemic: An International Perspective. Front. Psychiatry. (2020) 11:700. https://doi.org/10.3389/fpsyt.2020.00700.
- De Berardis D, Fornaro M, Vellante F, Orsolini L, Tomasetti C, Ventriglio A, et al. Earthquakes, economic crisis and, now, Covid-19: the cry of yell of Central Italy. Psychiatry Res. (2020) 291:113181. https://doi.org/10.1016/j.psychres.2020.113181.
- McCann Pineo M, Schwartz RM. Commentary on the coronavirus pandemic: Anticipating a fourth wave in the opioid epidemic. Psychol Trauma: Theory Res Pract Policy. (2020). https://doi.org/10.1037/tra0000622.
- Marchei E, Pacifici R, Mannocchi G, Marinelli E, Busardò FP, Pichini S. New synthetic opioids in biological and non-biological matrices: A review of current analytical methods. Trend Anal Chem. (2018) 102:1–15. https://doi.org/10.1016/j.trac.2018.01.007.
- Solimini R, Pichini S, Pacifici R, Busardò FP, Giorgetti R. Pharmacotoxicology of Non-Fentanyl Derived New Synthetic Opioids. Front Pharmacol. (2018) 9:654. https://doi.org/10.3389/fphar.2018.00654.
- Ornell F, et al. “The COVID-19 Pandemic and Its Impact on Substance Use: Implications for Prevention and Treatment.” Psychiatry Research. (2020) 289:113096. https://doi.org/10.1016/j.psychres.2020.113096.