“More than 20 million people in the United States have a substance use disorder. Now, COVID-19 has left many locked down, laid off, and flooded with uncertainty. So far, experts see signs of relapses, rising overdoses, and other worries. What can be done?

Dave Quisenberry is determined to stay away from opioids, which have robbed him of so much. When COVID-19 put his building services job on hold for many weeks, though, the 48-year-old West Virginian kept looking over his shoulder to make sure loneliness wasn’t catching up with him.

“Being alone five days in a row can get to you, can make you anxious and depressed,” he says. “Back when I was using, I would just take care of that [with drugs].” Now, Quisenberry — who became addicted following shoulder surgery — says the possibility of relapse is always in the back of his mind. When he needs to steady himself, he makes sure to think about his family. “I don’t ever want to lose their trust again.”

Quisenberry is also glad that he’s been called back to work. “I know a lot of people in my support groups who have lost their jobs, which is completely miserable,” he says. “It’s a really bad deal right now for a lot of people who are trying to avoid drugs.”

Across the United States, as the COVID-19 pandemic has collided with the substance use epidemic, experts worry about the vast numbers of people who may be suffering from the impact.

Anxiety, grief, isolation, financial worries, changes at home and work, and an ongoing sense of uncertainty can all threaten people with a substance use disorder (SUD) as well as those at risk of developing one.

Researchers say it’s too soon to have definitive data on the pandemic’s effects, but early numbers are concerning. So far, alcohol sales have risen by more than 25%. A recent analysis of 500,000 urine drug tests by Millennium Health, a national laboratory service, also showed worrisome trends: an increase of 32% for nonprescribed fentanyl, 20% for methamphetamine, and 10% for cocaine from mid-March through May. And suspected drug overdoses climbed 18% in the same period, according to a national tracking system run out of the University of Baltimore.

On the ground, providers who treat SUDs note a complex mix of experiences among those needing care.

Sometimes, patients were loath to seek SUD treatment in the early days of the pandemic for fear of contracting COVID-19. Others who sought help had trouble finding it as facilities limited services or even closed. Some patients did well, as lockdowns kept them away from drug-using peers, but many others struggled with isolation.

“At first, some of our patients were resilient and resourceful in staying drug-free,” says Daniel Buccino, clinical manager of the Johns Hopkins Broadway Center for Addiction. “As time went on, it started getting harder for them, and I’ve been seeing drug use going up.”

What’s more, drug use during COVID-19 can be particularly deadly. As the pandemic hobbled illicit drug supply chains, people with SUDs sometimes turned to new dealers or unfamiliar drugs — with unforeseen and dangerous consequences. In addition, more people have been overdosing alone, with no one nearby to help. “We’re seeing more overdose cases going straight to the morgue rather than to the emergency department,” says Buccino.

Before the pandemic, drug use had already burned a path across the country. In 2018, the number of people with an SUD related to illegal drugs or alcohol topped 20 million. Of those, 2 million had an opioid use disorder.

Now, factors that usually fuel substance use are heightened by the pandemic, experts say. For one, research shows that drug use often increases during economic downturns.

Stress is also a common trigger for those at risk of relapse.

“Someone trying to recover from a substance use disorder has a physiological hypersensitivity to stress due to the effects of the substance on their central nervous system,” explains John Kelly, PhD, director of the Recovery Research Institute at Massachusetts General Hospital. “They’re just more easily stressed than other people.

“In addition, chronically exposing the brain to drugs like opioids decreases a person’s ability to experience normal levels of rewards,” he says. “Reduced enjoyment combined with stress and isolation can really take people back over the edge into active problem use.””

Read the full article by Stacy Weiner, AAMC here.

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