By: Chapel Taylor-Olsen, BA, Health & Wellness Coordinator & Dr. Ashley Yaugher, Health & Wellness Faculty, HEART Initiative; Utah State University Extension

 The opioid crisis has been claiming thousands of American lives per year for decades. Now, this healthcare crisis is colliding with a new threat sweeping the world: the novel coronavirus, COVID-19. This article reviews the mental health impacts of COVID-19 on Americans; unique impacts on people with opioid use disorder (OUD); and five ways you can help a loved one with OUD during COVID-19 and beyond.

 Mental Health and COVID-19

2020 has found many of us considering, worrying about, and longing for, things that we never would have guessed. The many changes, such as job losses and decreased social support, due to COVID-19 are having major impacts on our mental health. In fact, the National Center for Health Statistics (NCHS, 2020), has been conducting weekly surveys since mid-April to track the mental health impacts of COVID-19 on adult Americans. Their findings show that from April 23 – July 21, 2020 the percentage of U.S. Adults with symptoms of anxiety or depression has been between 33.9 – 40.3% with the highest percentages occurring in June and July 2020. This is triple the number of past years. For instance, from January – June 2019, only 11% of American adults had symptoms of an anxiety or depressive disorder (NCHS, 2020). This is particularly problematic for people who are also facing other mental health concerns such as people with opioid use disorder (OUD). People who experience symptoms of anxiety and/or depression are at higher risk of experiencing substance use disorders (including OUD; Busch et al., 2019; Tong et al., 2019). People with OUD are an already marginalized group in our society – they are often treated unfairly because of their condition and may experience high amounts of stigma or shame (Becker & Fiellin, 2020; Slavova et al., 2020).

 OUD and COVID-19

People with OUD during this pandemic face increased health risks and the reasons are complicated. For marginalized people who are in recovery or are currently experiencing OUD this stressful time puts excessive strain on their support systems and increases their risk of substance use and possibly a fatal overdose (Becker & Fiellin, 2020; Slavova et al., 2020). Social distancing measures, business and non-profit closures, and other challenges increase stigma and decrease access to treatment (Becker & Fiellin, 2020; Slavova et al., 2020; McGinty at al., 2018). In addition, many people with substance use disorder have other pre-existing conditions that put them at higher risk for serious respiratory symptoms if they were to contract COVID-19 and substances can increase the effects of COVID-19 (EMCDDA, 2020; UNODC, 2020). For example, opioids slow breathing which, when combined with any illness affecting the lungs, can increase the risk of death (Becker & Fiellin, 2020; EMCDDA, 2020). Additionally, strain on social support systems means people with OUD find decreased access to care of all kinds. This can lead to increased substance use.

 Data suggests that during the COVID-19 pandemic there has been an increase in heroin (i.e., an illicit substance) use and an increase in fentanyl use (Millennium Health, 2020). Fentanyl is a synthetic opioid between 50 –100 times stronger than morphine which is often combined with other substances without the person using the substances knowledge and is increasingly involved in deadly overdoses (CDC, 2020). When experts see shifts toward the use of more lethal types of opioids, as is happening now, they worry that an increase in deaths by overdose will soon follow. Emergency responders in some communities, like Kentucky, have seen a horrifying 50% increase in suspected opioid overdose deaths during this time (Slavova et al., 2020). These concerning increases in overdose deaths are being felt around the U.S. and the world (Millennium Health, 2020; UNODC, 2020). 2020 is seeing more overdose deaths in rural areas than ever before, highlighting an increased need for harm reduction services (Alter & Yeager, 2020). At the best of times, it is challenging to gain public support for many life-saving harm reduction strategies, including syringe distribution programs and safe consumption sites that decrease overdose deaths and other harms (McGinty et al., 2018). Now, with our health care system under extreme strain, and the most vulnerable at high risk for COVID-19, people with OUD find themselves more marginalized and at higher risk than ever before (Becker & Fiellin, 2020). Health departments and behavioral health providers everywhere are facing challenges providing in-person therapy, distributing medication, continuing syringe services, and distributing naloxone (Slavova et al., 2020; Alexander et al., 2020). The Substance Abuse and Mental Health Services Administration (SAMHSA) has encouraged providers to engage in mobile outreach programs for methadone (i.e. a medication used to treat opioid use disorder) distribution to support people who are in recovery and Medicaid/Medicare waivers that allow people access to telehealth have also been beneficial (Alexander et al., 2020). Fortunately, telehealth is an effective model for delivery of therapy and other needed services (Perle & Nierenberg, 2013).

 More support is urgently needed to link people, particularly those with OUD, to social service programs and comprehensive case management in order to avoid harming their recovery (Alexander et al., 2020; Becker & Fiellin, 2020).

 How You Can Help the Opioid Crisis During COVID-19

One of the most valuable things you can do to help support someone with mental health or OUD’s is to reach out and offer your support in a non-stigmatizing way. If you or a loved one are experiencing OUD or symptoms of depression or anxiety, there is help and hope. Here are just a few ways to help during this tale of two crises:

1. Reach out to people in your life with OUD: Pick up the phone, send a text, maybe even write a letter! Feeling stigmatized, marginalized, and cut off is corrosive to our sense of safety and stability. Connection is an important healing tool for us all. Remember to use person first language (e.g., “person with OUD” rather than “opioid addict;”) and use I sentences (e.g., “I have noticed that you have seemed down lately, want to talk?” rather than “You are feeling down, why can’t you suck it up?”)
2. Share resources: Encourage use of support services and treatment services for those in need. Find out about local resources for mental health support in your area, check out the resources below for information on national resources, and share them. When we are in the middle of a difficult time, simply finding the help that we need can feel like an overwhelming task. Shorten the path to finding help for someone in your life.
3. Join your local coalitions: We are all in this together and many prevention coalitions have moved their meetings online to continue their work. Find out what groups in your area are doing to support people with substance use disorders and impact public policies.
4. Carry naloxone: Be prepared at home, work, and anywhere you go. Learn how to use naloxone with the resources below and carry it with you to help save lives. Remember to always call 911 first, when you suspect an overdose, and then administer naloxone.
5. Listen to stories of the opioid crisis: Listening to the experiences of people who have had OUD is a great way to build an understanding of this crisis, that treatment works and recovery is possible, and ways to help. USU Extension Informing the National Narrative, Stop the Opidemic, and CDC Rx Awareness are three great sources for real world stories from this crisis.

 Mental Health Resources:

• SAMHSA: Resources for Families Coping with Mental and Substance Use Disorders: https://www.samhsa.gov/families
• National Suicide Prevention Hotline: https://suicidepreventionlifeline.org/
• National Alliance on Mental Illness: https://nami.org/Support-Education
• Behavioral Health Treatment Services Locator: https://findtreatment.samhsa.gov/
• American Psychological Association Psychologist Finder: https://locator.apa.org/

 OUD Resources:

• Find Free Naloxone Kits: https://www.drugabuse.gov/drug...aloxone-narcan-evzio
• Dispose of Unused Medications - FDA Medication Drop Box Locator: https://www.fda.gov/drugs/disp...-take-back-locations
• Prevent Opioid Use Disorder by Utilizing Non-Opioid Alternatives for Pain: https://extension.usu.edu/hear...niquesforchronic.pdf
• National Institute on Drug Abuse (NIDA): https://www.nih.gov/about-nih/...tute-drug-abuse-nida

 Stories & Other Resources

• Informing the National Narrative: Stories of Utah’s Opioid Crisis: https://digital.lib.usu.edu/di...ection/p16944coll134
• Stop the Opidemic: https://www.opidemic.org/stories/
• CDC Rx Awareness Campaign: https://www.cdc.gov/rxawareness/index.html

References

Alexander, G. C., Stoller, K. B., Haffajee, R. L., & Saloner, B. (2020, April 2). An epidemic in the midst of a pandemic: Opioid use disorder and COVID-19. Annals of Internal Medicine. doi:10.7326/M20-1141.

Alter, A. & Yeager, C. (2020, May). COVID-19 Impact on US National Overdose Crisis. Overdose Detection Mapping Application Program. Retrieved from http://www.odmap.org/Content/d...Report-June-2020.pdf 

Becker, W. C. & Fiellin, D. A. (2020, April 2). When epidemics collide: Coronavirus disease 2019 (COVID-19) and the opioid crisis. Annals of Internal Medicine, 173, 59-60. doi:10.7326/M20-1210 

Busch, C. Z., DuPaul, G. J., Anastopoulos, A, D., Franklin, M. K., Jaffe, A. R., Stack, K. F., & Weyandt, L. L. (2019). First-year college students with ADHD: risk for and correlates of alcohol and substance use. Journal of Postsecondary Education and Disability, 32(4), 377-393. Retrieved from https://eric.ed.gov/?id=EJ1247074

Centers for Disease Control and Prevention [CDC]. (2020, March 19). Fentanyl. Retrieved from https://www.cdc.gov/drugoverdo...pioids/fentanyl.html

European Monitoring Centre for Drugs and Drug Addiction [EMCDDA]. (2020, March 25). EMCDDA update on the implications of COVID-19 for people who use drugs (PWUD) and drug service providers. Retrieved from https://www.emcdda.europa.eu/p...people-who-use-drugs

McGinty, E. E., Barry, C. L., Stone, E. M., Niederdeppe, J., Kennedy-Hendricks, A., Linden, S., & Sherman, S. G. (2018). Public support for safe consumption sites and syringe services programs to combat the opioid epidemic. Preventative Medicine, 111, 73-77. doi: https://doi.org/10.1016/j.ypmed.2018.02.026

Millennium Health. (2020, July 8). Millennium Health’s Signals Report COVID-19 Special Edition Reveals Significant Changes in Drug Use During the Pandemic. Retrieved from https://www.millenniumhealth.c.../signalsreportcovid/ 

National Center for Health Statistics. (2020). Mental Health: Household Pulse Survey. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/nchs/covid...se/mental-health.htm

Perle, J. G. & Nierenberg, B. (2013) How psychological telehealth can alleviate society's mental health burden: A literature review. Journal of Technology in Human Services, 31(1), 22-41, doi: 10.1080/15228835.2012.760332

Slavova, S., Rock, P., Bush, H. M., Quesinberry, D., & Walsh, S. L. (2020). Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug and Alcohol Dependence, 214. doi: https://doi.org/10.1016/j.drugalcdep.2020.108176

Tong, V. T., Zhou, J., Haight, S. C., & Ko, J. Y. (2019). Treatment of substance use disorders among women of reproductive age by depression and anxiety disorder status, 2008–2014. Journal of Women’s Health, 28(8), 1068-1076. doi: http://dx.doi.org.dist.lib.usu...0.1089/jwh.2018.7597 

United Nations Office on Drugs and Crime [UNODC]. (2020) COVID-19 and the drug supply chain: From production and trafficking to use. Retrieved from https://www.unodc.org/document...ly-chain-Mai2020.pdf   

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