In 2018, U.S. deaths from drug overdoses fell for the first time in 25 years, largely owing to advances in curbing prescription opioid abuse. But in 2019, overdose fatalities-from opioids but also methamphetamines and cocaine-edged up nationwide to record levels, according to the Centers for Disease Control and Prevention. Deaths increased in more than 30 states, with some cities and states reporting spikes as high as 50%. Preliminary figures suggest overdose deaths in 2020 may be even higher, in part because of the COVID-19 pandemic, which has disrupted addiction recovery programs and diverted resources.

Figure. Patients pick up medication for opioid addiction at a clinic in Olympia, Washington, that meets patients outdoors and offers extended prescriptions in hopes of reducing the number of visits and the risk of coronavirus infection. Photo by Ted S. Warren / AP Photo.

COVID-19 has dramatically altered access to medication and treatment for people with substance abuse disorders. Before the pandemic, rules restricting the dispensing of methadone for addiction treatment required patients to travel daily to a licensed opioid treatment program (OTP) to receive medication. To reduce novel coronavirus infection risk and avoid disruptions in patient care, the U.S. Substance Abuse and Mental Health Services Administration established new guidelines allowing OTPs to eliminate prior authorizations and prescribe methadone for patients to take home. Medicare and Medicaid expanded treatment access by increasing coverage of telehealth services.

While these measures to eliminate in-person contact and ease barriers to effective medication have lowered infection risk, addiction specialists say they have increased the chances of relapse, since many addiction patients depend on comprehensive care that includes housing and social services. The pandemic has forced some treatment centers to close or scale back operations precisely when their patients are suffering economic hardships-job loss, food insecurity, homelessness-and urgently need human connection. Loneliness, isolation, anxiety, and unemployment are significant factors fueling the resurgent opioid epidemic.

The U.S. government has allocated $6 trillion so far to fight COVID-19. But that has required shifting resources from other priorities, including a billion-dollar research project to develop safer opioid treatments. While a global disease outbreak of such magnitude demands swift action, public health officials warn that the effect may be to supercharge the drug abuse epidemic, resulting in many additional lives lost.-Lucy Wang Halpern