Substance Use Disorders and COVID-19: Multi-Faceted Problems Which Require Multi-Pronged Solutions

Abstract

COVID-19 shocked health and economic systems leaving millions of people without employment and safety nets. The pandemic disproportionately affects people with substance use disorders (SUDs) due to the collision between SUDs and COVID-19. Comorbidities and risk environments for SUDs are likely risk factors for COVID-19. The pandemic, in turn, diminishes resources that people with SUD need for their recovery and wellbeing. This article presents an interdisciplinary and international perspective on how COVID-19 and the related systemic shock impact on individuals with SUDs directly and indirectly. We highlight a need to understand SUDs as biopsychosocial disorders and use evidence-based policies to destigmatize SUDs. We recommend a suite of multi-sectorial actions and strategies to strengthen, modernize and complement addiction care systems which will become resilient and responsive to future systemic shocks similar to the COVID-19 pandemic.

Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse

“…Psychosocial distress might be particularly challenging for patients with SUDs, since social distancing and quarantine might intensify isolation and loneliness (32). In this context, living alone is associated with a greater risk of suffering from SUDs in older adults (33).…”

“…In fact, studies on economic crises found associations between an increase in unemployment with a substantial increase (28%) in mortality due to SUDs and higher numbers of suicide (4.5%) (34). Additionally, the pandemic disproportionately affects people with SUDs by diminishing resources that people with SUD need for their recovery and wellbeing (32).…”

Developments in Drug Addiction During COVID-19—An Austrian Perspective Based on a Clinical Sample

“…From our perspective, during lockdown only the main pharmacological supply of these patients was enabled, while long-term treatment including psychological and psychiatric support was nearly impossible due to restricted access to all outpatient clinics. For the future, it is important to provide patients suffering from addictive disorders with all possible resources in order to maintain a high standard in addiction care practice, including use of telehealth and adopting proactive policies (3). In this context, we strongly recommend the EMCDDA's conclusion that developments in the area of PWUD due to COVID-19 should be closely monitored in respect to potential risky and hazardous patterns of use (23).…”

“…The impact of COVID-19 might be particularly challenging for vulnerable populations (1) including people suffering from substance use disorder (SUD) (2). The reciprocal impact between Covid-19 and SUD have been described, categorized in spread of disease, risk of infection, increased severity of COVID-19 symptoms, psychological stress, and reduced access to addiction treatment services (3). Reports from different countries suggest reduced availability of illicit and prescribed drugs, altered consumption patterns, higher probability of relapse, and even elevated risk of deadly overdose without opportunity for rescue due to social distancing and isolation (4)(5)(6)(7)(8).…”

The Other Pandemic: Addiction

“…And the epidemic of substance use disorders (SUDs) related to COVID-19 is not confined to the US; there are similar reports from other afflicted nations, making addiction truly the other pandemic. 4 The Centers for Disease Control and Prevention reported that 13.3% of American adults have started or increased their substance use as a means of managing the negative emotions associated with the pandemic. 5 Also from March to May 2020, researchers in Baltimore found a 17.6% increase in suspected overdoses in counties advising social distancing and/or mandating stay at home orders.…”