As the world strives to move forward from the effects of COVID-19 in a positive light, many negative consequences remain a persistent threat. There is an undeniable connection between pandemic-related stress and mental health concerns. The attention now is on substance abuse. Public health and the medical community warned us that the societal pressure due to the COVID-19 pandemic created “a perfect storm’’ for a new opioid crisis.
As the pandemic presented itself to the world, the medical environment took note of the increase of psychological dangers to come. In March 2020, less than two weeks after the number of confirmed COVID-19 cases surpassed 100,000 globally, the World Health Organization (WHO) issued a document on “Mental health and psychosocial considerations during the COVID-19 outbreak.” The predictions were correct—anxiety and depression rates quickly began to rise. By June 2020, the Center for Disease Control (CDC) reported that the number of adults older than 18 who experienced anxiety disorders increased to 25.5%, a sharp increase from the previous year’s percentage of 8.1 (Czeisler et al., 2020). Similarly, more people reported symptoms of depressive disorders during this time as compared to 2019, with the percentage rising from 6.5 to 24.3. (Czeisler et al., 2020).
While health fears, financial concerns, and social isolation mandates are attributed to an increase in mental health disorders, could science also link the pandemic and the measures taken to mitigate its spread with an increase in opioid misuse and overdose?
The existing data suggest a correlation between increased opioid-related emergency visits and social isolation mandates. In one study, data from the National Emergency Medical Services Information System (NEMSIS) was used to analyze the overall pattern of opioid-related Emergency Medical Service (EMS) events in pre-COVID years (from 2018 to 2019), as well as during the pandemic in 2020 (Khare et al., 2022). From March to June 2020, when stay-at-home orders were in full effect, the number of EMS runs decreased due to public fears of contracting COVID-19 in the hospital. In contrast, the number of daily opioid-related EMS runs increased in the spring of 2020 compared with the same period in previous years. Moreso, researchers found changes in the trends of opioid-related EMS runs when stay-at-home orders went into effect. As the orders expired in June 2020, opioid-related EMS runs steadily decreased. Corroborating the EMS-based findings, the CDC reported an increase in nonfatal overdoses using the data from hospital emergency room visits, along with drug overdose deaths, which accelerated from March through May 2020 (CDC, 2021/CDC-HAN).
While correlation does not define causation, the findings from the EMS data (Khare et al., 2022) have significant implications that lawmakers can utilize to increase public safety. Currently, public health decisions are based on mortality data, which has a considerable delay compared to EMS data, which is continuously collected. Therefore, relying on mortality data limits the proactiveness of public health programs. EMS data may serve as an early warning system for local health jurisdictions to deploy harm reduction/prevention resources. If EMS data can help build a more effective and proactive opioid-abuse program, perhaps public health agency leaders should instead use this data to influence their decisions.
CDC-HAN, Health Alert Network. Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic.
CDC, 2021. Suspected Nonfatal Drug Overdoses during COVID-19.
Czeisler, M.É., Lane, R.I., Petrosky, E., Wiley, J.F., Christensen, A., Njai, R., Weaver, M.D., Robbins, R., Facer-Childs, E.R., Barger, L.K., Czeisler, C.A., Howard, M.E., Rajaratnam, S.M.W., 2020. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic – the United States, June 24-30, 2020. MMWR. Morbidity and mortality weekly report 69(32), 1049-1057.
Khare A, Sidana A, Mohammed A, Allicock AM, Waterstone A, Zimmer MA, Il’yasova D. Acceleration of Opioid-Related EMS Runs in the Spring of 2020: The National Emergency Medical Services Information System Data for 2018-2020. Drug Alcohol Depend. March 2022, v. 232, 109271. https://doi.org/10.1016/j.drugalcdep.2022.109271
WHO, Mental health and psychosocial considerations during the COVID-19 outbreak.