Pandemic Fuels Rise in Drug-Related Deaths
A University of Arizona pharmacologist discusses how the conditions created by the pandemic and the response could be exacerbating drug use and overdose.
In Arizona, there's been a recent uptick in drug overdoses. There were 463 deaths reported in March, and throughout the summer the number of deaths per month has remained higher than most month-to-month totals in 2018 and 2019. Numbers are expected to continue to climb as more medical reports are confirmed.
In July, the American Medical Association published a brief report on increases in opioid overdoses in the United States in the wake of the COVID-19 pandemic, in which they urged governors and state legislatures to take action.
The pandemic is exacerbating many risk factors associated with increased drug use and overdose, including economic distress, social isolation and anxiety. The pandemic has also made it more difficult and scarier for some individuals to receive treatment for their substance use disorder from both treatment clinics or emergency departments, says Todd Vanderah, head of the Department of Pharmacology in the University of Arizona College of Medicine – Tucson.
Vanderah is the new director of the university's Comprehensive Pain and Addiction Center, or CPAC. There, he works with faculty, administration, staff and volunteers to make rapid advances in research, clinical care, education and legislation on chronic pain and substance use disorder.
His aim is to bring together all of the independent University of Arizona pain and addiction groups in both Tucson and Phoenix in order to advance research and clinical care while providing resources and opportunities to educate and make real changes in a difficult and fast-growing field.
The U.S. Human Resources and Services Administration recently granted the center $2.2 million to start the University of Arizona's first paraprofessional program that will train individuals in helping families, especially children and adolescents, with substance use disorders, including opioid addiction.
Vanderah talked about what's going on behind the scenes of the pandemic and some solutions.
Q: What types of drug use are on the rise?
A: We're seeing a rise in fentanyl, methamphetamine and benzodiazepines like Xanax. For example, in Pima County, the Health Department is projecting 156 Fentanyl-related drug deaths in 2020. This is up from 89 in 2019.
Q: Is the trend related to COVID-19 and staying at home? How does usage compare before and after widespread stay-at-home orders and closures?
A: While this continues a trend of year-to-year increases, it is likely that COVID-19 contributed to the large increase in 2020. In Arizona, after stay-at-home orders went into effect at the end of March, there was a subsequent spike in April and May's monthly death rates compared to previous months. Individuals are more cautious and continue to practice physical distancing. Unfortunately, this also reduced opportunities for assistance and care, including volunteer groups and other social services that have been negatively impacted by COVID-19.
Q: Are more people becoming addicted or are more people relapsing because they're scared of seeking help right now?
A: It's hard to tell. My guess is that it is both. Many people have been increasing their intake of alcohol, which is easier to track because of sales, but this leads me to believe that illicit drugs are also being more consumed due to the overall depression that COVID-19 has put upon the world. The loss of social interactions, the loss of jobs and the loss of loved ones is very devastating and can lead to a "who cares" attitude and substance misuse.
Q: How is the pandemic affecting facilities that would usually provide aid and resources?
A: Talking with health care professionals, we've heard anecdotal reports of large decreases in care utilization. For example, among people who overdose in one rural Arizona county, EMS has seen a threefold decline in patients agreeing to be transported to the hospital. Patients report concern about the risk of COVID-19 exposure. Methadone clinics also observed dramatic reductions in patient enrollments in the early months of the COVID-19 emergency. It is clear that COVID has increased the risks for using drugs and reduced the likelihood of receiving care.
Q: What are some of the implications of this outbreak?
A: I believe we are going to have another large wave of substance use disorder due to this pandemic. Unfortunately, this can also lead to the spread of other diseases like hepatitis, HIV or COVID-19. Widespread mask wearing is important, as is ensuring our community can access care. That starts with affordable insurance coverage and access to services via telemedicine.
Q: What are some solutions?
A: A multi-pronged approach that begins with first understanding individuals with substance use disorder and not judging individuals. CPAC supports the shift from the traditional, criminal justice and punishment approach to one that emphasizes treatment and support. This involves medications to help individuals treat their substance use disorder and surrounding them with a support team that includes psychiatrists, psychologists, therapists, recovery support specialists, family and friends. Needed is more research, long-term care and education on helping those who suffer from substance use disorder. At CPAC, we are addressing these issues by achieving federal funds to start a paraprofessional program that will train individuals to support folks who use opioids and their families, including children, adolescents and parents. We are also submitting a Federal NIH Center Grant to study the central nervous system and the decision-making process of using illicit drugs as a method of preventing the onset of substance use disorder. Finally, we are working with clinical partners in testing novel, non-addictive efficacious pain medications in order to reduce or completely remove the need for opioids, and with partners in pediatrics and OB/GYN to help babies that suffer from neonatal abstinence and mothers with substance use disorder.
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