Navigating intersecting public health crises: a qualitative study of people with opioid use disorders' experiences during the COVID-19 pandemic

Abstract

Background The decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD). Most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data. There is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time. The current study examines understandings and experiences of people with OUD while they have navigated these crises. Methods The study was guided by a pragmatic lens. We conducted brief semi-structured qualitative interviews with 25 individuals in Chicago, the majority of which had received methadone treatment during the pandemic. Thematic inductive analysis was guided by primary interview questions. Results The sample represents a high-risk group, being composed mostly of older non-Hispanic African American males and having considerable socioeconomic barriers. Themes demonstrate how individuals are keeping safe despite limited knowledge of COVID-19, how the pandemic has increased treatment motivation for some, how adaptations impacted treatment and recovery supports, how the availability social support had been reduced, and difficulties individuals had keeping or obtaining financial support. Conclusions The findings can be useful for informing future public health response to ensure appropriate treatment access and supports are available. In particular are the need for treatment providers to ensure people with OUD receive appropriate and understandable health crisis-related information and ensuring funds are appropriately allocated to address mental health impacts of social isolation. Finally, there is a need for appropriate financial and infrastructure supports to ensure health and treatment access disparities are not exacerbated for those in greatest need.

Geographic variations in opioid overdose patterns in Pennsylvania during the COVID-19 pandemic

“…In particular, our findings demonstrate a need for more informed policy interventions that attend to the differential experiences and place-based realities of OUD providers and those struggling with addiction. Ensuring funds are appropriately allocated to address the effects of social isolation and broader social and structural inequities would not only help mitigate relapse and overdose during the pandemic but provide a foundation on which to expand care provision ( Silva and Kelly, 2020 ; Watson et al, 2022 ). As the COVID-19 pandemic continues to unfold in new and uncertain ways, attention to the contextual realities of people with OUD is essential to avoid unintended consequences of well-meaning policies, such as the rise in overdose following the 2020's shelter in place orders and social distancing measures ( Glober et al, 2020 ; Rodda et al, 2020 ; Slavova et al, 2020 ; Rosenbaum et al, 2021 ).…”

“…Existing research is demonstrating that with expanded access to naloxone, opioid morbidity represents a significant component of overdose incidents ( Scholl et al, 2018 ; Zibbell et al, 2019 ; Holmes et al, 2022 ). Existing studies also focus more on overdose rates and trends during the pandemic with less attention to the socio-geographic correlates of these trends, or the lived realities of OUD providers during the pandemic ( Glober et al, 2020 ; Alter and Yeager 2020 ; Rosenbaum et al, 2021 ; Watson et al, 2022 ). Thus, little is yet known about how these trends play out across disparate geographies, how overdose rates in 2020 compared to years prior to the pandemic, and how existing social and economic vulnerabilities may have combined with the trauma of the pandemic to transform the U.S. opioid epidemic.…”

“…Given the ways that the COVID-19 pandemic is potentially intensifying the factors that contribute to substance misuse, research on the socio-geographical variations in opioid misuse would assist in addressing place variations in substance use, addiction patterns, and treatment responses. As Watson et al (2022 ; 1) argue, although “the decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD) … most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data.” The consequence is that the place-specific factors underpinning these variations, along with the ways opioids are differentially experienced among the population, are underemphasized in the existing literature. Indeed, they conclude that “there is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time” ( Watson et al, 2022 ; 1).…”

“…As Watson et al (2022 ; 1) argue, although “the decades-long opioid epidemic and the more recent COVID-19 pandemic are two interacting events with significant public health impacts for people with opioid use disorder (OUD) … most published studies regarding the intersection of these two public health crises have focused on community, state, or national trends using pre-existing data.” The consequence is that the place-specific factors underpinning these variations, along with the ways opioids are differentially experienced among the population, are underemphasized in the existing literature. Indeed, they conclude that “there is a need for complementary qualitative research aimed at identifying how people with opioid use disorder (OUD) are understanding, experiencing, and navigating this unprecedented time” ( Watson et al, 2022 ; 1). Equally, more work that considers the differential needs, experiences, and realities of OUD health providers are needed to explicate the social and structural drivers underpinning geographic variations to ensure opioid users have timely access to the full continuum of evidence-based interventions ( Marchand et al, 2022 ; McCann et al, 2022 ).…”

“…These interacting economic and environmental conditions generated the boom for towns in Southwest Pennsylvania during the 1940s and 1950s, and subsequent industrial decline, which is credited for contributing to outmigration, economic decline, and increasing crime that are tied to the opioid epidemic ( Guza 2014 ). As the COVID-19 pandemic continues to inflict uneven realities for opioid users OUD health providers, research and policy attention to opioid use and misuse remains urgently needed ( Glober et al, 2020 ; McCann et al, 2022 ; Rosenbaum et al, 2021 ; Watson et al, 2022 ).…”