A Google search that contains the words “overdoses” and “lockdown” will produce pages of headlines on the record numbers of deaths caused by drug overdoses during the COVID-19 pandemic in the United States and Canada. 81,000 people died of opioid overdoses in the U.S. between June 2020 and June 2021; this was the highest number of opioid deaths of any year in the country, and 20% more than the previous year. In Canada, a study conducted by The Science Table found that the rates of deaths from opioid overdoses increased by 60% in Ontario between the start of the pandemic in March 2020, and the time of their report in September 2021.
Increases were larger for people living in poverty or homelessness, individuals in jail, and BIPOC communities. As the newest COVID-19 variant, Omicron, is spreading and leading to many states and provinces choosing to re-enact lockdown measures, these numbers, and the people at risk of opioid overdoses, need to be considered when considering new public health measures.
The Centers for Disease Control and Prevention (CDC) in the U.S. has put out some recommendations to states in responding to the opioid crisis. One is ensuring that services remain available for individuals at risk of overdose during lockdowns. This is often seen in offering virtual appointments and support groups. Another recommendation is to increase the availability of naloxone, which can be used to reverse an opioid overdose, and to increase education on how to avoid overdosing, and how to use naloxone when needed.
Other recommendations from the CDC include intervening earlier with those at risk of overdose and improving the detection of outbreaks to assist in faster and more efficient responses. In Canada, some significant steps taken have included increasing the number of Substance Use and Addictions Programs, an Emergency Treatment Fund to increase access to treatment, increasing supervised consumption sites, and increased education and awareness of opioids and how to respond to an overdose. In December 2021, Canada introduced Bill C-5, which is a proposal to remove mandatory minimum penalties for drug offences and to require police and prosecutors to attempt to use diversion, such as offering treatment programs instead of charges, for acts such as drug possession. If the bill passes, it could be an important step for increasing access to treatment, responding to drug possession, and using programs aimed at helping rather than punishing the crime.
The steps being taken by both the CDC and Canadian Government in response to the opioid overdose crisis are important and make some impact. However, the COVID-19 specific responses seem to be limited. COVID-19 has exacerbated the opioid crisis because of several factors. Experts have said that the most significant factor is the result of isolation. Individuals already at risk of opioid overdose are taken away from their social support systems during lockdown measures; this is especially an issue for those without access to phones or the internet.
COVID-19 has made it much more difficult to stay in touch with support groups, and more difficult for many to make appointments for treatment and support. Isolation has also created more privacy, making it easier to abuse substances, and meaning it is more likely there will not be anyone there to help in the event of an accidental overdose. Another issue caused by COVID-19 is that funding has been cut to addiction treatment programs because of a lack of funding caused by the pandemic. It has also become more difficult to access mental health support during the pandemic. Another issue is that many people are scared to seek help because of COVID-19, and will wait longer to seek treatment.
Changes in the supply chain due to border closures and travel restrictions have led to many people finding new sources to buy from, and this increases the risk of unsafe drug use and using laced drugs. Although the public health measures taken to curb the COVID-19 pandemic are important, there has been a failure to recognize the negative impacts these measures have had. Robert Rodriguez, a physician at Zuckerberg San Francisco General Hospital, has been quoted as saying that “while everyone’s focus is appropriately on the pandemic, we can’t lose sight of these other huge issues.” This summarizes the argument that when implementing measures to combat COVID-19, professionals also need to consider other issues, and the impacts that those measures might have on groups and people already vulnerable.
During COVID-19, attempts were made to increase virtual appointments, screen patients for the virus as they enter treatment facilitates, and take other measures to ensure continued support for those at risk of opioid overdose. These measures are important; however, they are not working for everyone. Many people find it difficult to build the same level of trust in a virtual appointment, making it more difficult for people new to treatment to receive the same level of service they could receive in person.
Many people do not have access to a cell phone or the internet and are then unable to access these new forms of services. The responses made by treatment centers, hospitals, and experts working to help those at risk of opioid overdoses are helping the problem in the best ways they can, and it is difficult to do better given the current restrictions and the environment created by the pandemic. The place that changes needs start responding to the increase in overdoses during the pandemic is at the level of public health agencies and governments making the decisions around lockdowns and restrictions.
Deciding on what public health measures to impose during this pandemic has, no doubt, been a major challenge for governments and public health officials. Two key objectives should be thought of when imposing restrictions. The first is what needs to be done to minimize the spread of COVID-19 and to keep the most vulnerable to the virus safe from it. The second is to minimize the negative impacts of those restrictions on those who are vulnerable to suffering from isolation, loss of services, loss of employment, and other factors. The balance between these objectives is a difficult one to find. The increase in deaths from opioid overdoses in both the U.S. and Canada indicates that the second objective has not been successfully met for a lot of people. As states and provinces are entering new lockdowns with new restrictions, governments should ask themselves: what can we do differently to still protect people against COVID-19, but also better protect them against the impacts of the lockdowns?
For the issue of opioid overdoses, one option is to maintain funding to treatment programs and to list in-person addictions treatment as an essential service. Unlike at the start of the pandemic, we now have access to rapid tests so that people in need of these services could be tested before coming into contact with anyone. Social distancing and masking could also remain in place. Virtual appointments could stay open for those who feel unsafe entering an in-person setting, or those able to access and benefit from this form of appointment. Although offering an in-person option increases the risk of COVID-19 transmission, that risk needs to be considered alongside the amount it would decrease the risk of an opioid overdose.
Everything that can be done to protect individuals against COVID-19 should be done. At the same time, everything that can be done to keep individuals safe from other factors they are vulnerable to must continue to be done. Sometimes these two objectives conflict with one another, as in the case of in-person support for issues such as substance abuse. As has been seen with the increasing death rates during the pandemic, virtual appointments are not a suitable replacement for in-person appointments. For this reason, governments and public health agencies should do everything they can to keep those appointments in person and to combat the increasing crisis in Canada and the U.S. by the misuse of opioids.
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