Media seem to have stopped reporting on the opioid crisis despite the continued high numbers of overdose deaths, but we know the problem has not gone away. In fact, I can speculate that a variety of factors might affect interactions between opioid use disorders -- including withdrawal and overdose -- and COVID-19:
- Release of addicts from incarceration
- Social distancing and isolation of individuals
- Job loss
- Changes in provision of support by lay groups like NA and by treatment centers
- Loss of medical insurance due to job loss and reduced ability to pay
- Increased prescription of opioids to patients awaiting surgeries postponed due to COVID-19
- Addict/alcoholic high tobacco use increasing vulnerability to lung damage
- Personal neglect related to addiction leading to decreased compliance with directives intended to minimize exposure and transmission
- Changes in the black market for opioids
- Reduced likelihood of discovery of overdose victims by those who can help or summon help
I doubt the black market in opioids will jump into compliance with social distancing and other measures we hope will reduce the spread of coronavirus, although dealers -- and their customers -- might like the idea of wearing masks! More likely, with large numbers of people unemployed, away from classes and working from home, opportunities for buying, selling and using opioids will increase. Many of those released originally landed in jail on drug-related charges. They will not likely remain abstinent with freedom, especially without homes, income or treatment.
Physicians will likely prescribe more opioids to patients waiting even longer for joint replacement, steroid injection and other procedures that serve as alternatives to analgesics for addressing chronic pain.
Hope now lies mainly with medication assisted treatment in the form of methadone or buprenorphine, especially buprenorphine which has the potential to reduce the effects of overdose more safely than naloxone.
Restrictive drug policy -- prohibition and the "war" on drugs -- will continue to do more harm than good, both here in the U.S. and in Mexico.
Berry Edwards, MD