Recommendations for the overdose epidemic in the COVID-19 pandemic
A new report from researchers at the Johns Hopkins Bloomberg School of Public Health offers recommendations aimed at federal, state, and local policymakers to address the opioid epidemic during the pandemic, which has seen sharp increases in fatal and nonfatal overdoses. The recommendations detail policy solutions in the areas of data and surveillance, harm reduction, and treatment, with special considerations for vulnerable populations.
The report, Saving Lives from Overdose During a Pandemic, draws from peer-reviewed research on opioid overdoses, as well as recommendations from the World Health Organization and the Centers for Disease Control and Prevention.
A majority of states—more than 40—have reported increases in opioid-related deaths since the beginning of the pandemic, according to the ODMAP report, a mapping program that collects suspected fatal and non-fatal overdoses in real time across jurisdictions in the United States. Nationwide, there's been an 18 percent increase in overdoses since the beginning of 2020, according to ODMAP.
Among the new report's recommendations, the researchers provide guidance around increasing the capacity for state and local health departments to track and report changes in drug-related data during the pandemic. Specifically, they recommend using federal funding to support creating new data management systems that automatically assemble data to allow for more timely analysis. They also recommend that research focus on racial disparities and health inequities to inform equitable solutions to both the COVID-19 pandemic and the opioid epidemic.
The authors call for state and local jurisdictions to declare syringe service programs—community-based organizations that provide support services, linkages to substance use treatment, and access to safer drug use supplies—to be essential services during the pandemic. Many of these programs have been disrupted due to pandemic mitigation efforts, leaving clients with fewer resources. In addition, the report recommends that state and local jurisdictions issue emergency orders that make it easier to distribute harm reduction materials such as clean syringes and naloxone, a medication that reverses overdoses, to community-based organizations and service providers.
"The pandemic compounded an existing crisis—the opioid epidemic—with high unemployment rates, social isolation, and despair, all known risk factors for substance use," says Sara Whaley, MPH, MSW, research associate in the Bloomberg School's Department of Health Policy and Management and lead author of the report. "We have to support treatment providers, health departments, and other services that support people with substance use disorder, so they can provide essential, lifesaving services to those most in need."
The COVID-19 pandemic has resulted in nearly 18 million total cases in the U.S., and nearly 318,000 deaths, since January 2020. According to the Centers for Disease Control and Prevention, opioid-related overdoses accounted for over 47,000 deaths in 2018, the last year for which data are available. Drug-related deaths are four times greater than they were in the 1990s.
The report, issued by faculty at the Bloomberg School and several research collaborators, also drew from the Overdose Detection Mapping Application Program, open-source, and statewide data dashboards.
The report also recommends expanding access to substance use treatment, including medications like methadone and buprenorphine which are prescribed to reduce the negative effects of substance use. The researchers call upon Congress to appropriate additional funding to the Substance Abuse and Mental Health Services Administration to expand buprenorphine distribution via telehealth and delivery of methadone to patients at home. While federal rules now have more flexibility in these treatment options than prior to the pandemic, state restrictions may still be in place. The report calls for states to eliminate requirements that limit access to or billing for telemedicine. Finally, the researchers recommend increasing mobile treatment services to reach those living in poverty or experiencing homelessness as well as ensuring treatment providers have access to adequate personal protective equipment to protect themselves and the patients.
The researchers also suggest that states should utilize existing community health infrastructure of treatment and outreach programs to aid in the distribution of vaccines to critical populations of people who use drugs. They also recommend the release of people in jails and prisons who were arrested for low-level offenses, increased support of individuals released from jail or prison, and immediate provision of Medicaid coverage to individuals upon release. Additionally, they encourage states to prioritize emergency funding to establish COVID-19 shelters that accept individuals with substance use disorders.
"There are pathways to addressing the overdose crisis and the COVID-19 crisis together," says Joshua Sharfstein, MD, vice dean for Public Health Practice and Community Engagement, professor of Practice in Health Policy and Management, and director of the Bloomberg American Health Initiative. "This report provides a roadmap for saving lives."