The impact of the COVID-19 pandemic on people who use drugs

Calculating the true damage caused by the COVID-19 pandemic in the United States is a difficult task. We can note that more than 519,000 Americans have died due to complications from COVID-19 over the past year, but that number does not reflect all of the death and undue suffering this virus and our nation’s response have caused.

That jarring figure does not take into account those who died from otherwise treatable conditions that were neglected out of necessity due to an overtaxed public health system or were left unchecked out of individual fears of contracting COVID-19 while seeking care.

Those 519,000 dead do not encompass the suffering of the millions of Americans struggling with long term health effects from COVID-19. It also does not take into account the mental health struggles that come with being forced to work in public during a viral pandemic or to isolate ourselves for months on end.

The death toll also doesn’t cover the struggles of marginalized, often ostracized populations like people who use drugs or people who engage in sex work, who saw their support systems and access to health care disrupted by the pandemic.

To study the impact of COVID-19 on the people living with substance use disorder, a group of researchers from the Oregon Health and Science University School of Medicine conducted interviews with people who had been hospitalized for issues relating to substance use in the early months of the COVID-19 pandemic last spring. What they found reinforced the need to better “incorporate and amplify the voices of marginalized patients with SUD” in the development of health care systems for people who use drugs and to create programs that meet the stated needs of participants. The study also underscored the tremendous value of community-centered harm reduction programs and the importance of establishing a sense of shared trust between providers and clients.

Here are some of the more striking findings from the study:

1. Syringe service providers lead the way.

In interviews with the clients living with substance use disorder, a key theme that emerged was the frequent closure of community resources that were vital to their well-being. However, while many outpatient care providers and social services were disrupted, syringe services programs and other harm reduction providers were able to stay open and adapt during the early weeks of the pandemic. This flexibility and socially distanced, in-person service delivery was somewhat unique among medical providers and was tremendously beneficial to people who use drugs. When many doors were closing, syringe service providers stayed open.

2. Telehealth exclusivity.

When public health and outpatient substance use disorder recovery services transitioned to primary digital client interaction, some of the most vulnerable people who use drugs who did not have access to a smartphone or a laptop were left out in the cold. This exclusion was particularly cruel in the necessary switch of many support groups to virtual spaces, turning a once free community resource into one with a financial barrier to entry.

3. COVID risks of getting care.

For many people who use drugs, fear of contracting COVID-19 led them to wait until the last second to seek medical care. This is certainly not unique to this population, but for preventable or treatable issues like abscesses, MRSA, cellulitis, endocarditis and others, that wait can be devastating.

4. Struggling with isolation.

While many of us are struggling with feelings of isolation, already marginalized populations like people who use drugs are being hit particularly hard. With no outside support systems allowed to enter inpatient facilities and personal protective equipment and social distancing dehumanizing interaction, substance use disorder care is lonelier than ever.

5. Transition woes.

Discharge from inpatient stays for people who use drugs have always been difficult, but COVID-19 has introduced new layers of worry and potential calamity with the possibility of contracting the virus, lessened social supports and higher rates of homelessness. At the same time, employment is much harder to find for those who are trying to find stability after discharge. On top of these struggles, threats to personal mental health caused by the pandemic have made all of these normally difficult tasks even harder.

To learn more about the study or to understand the impact of the COVID-19 pandemic on hospitalized patients with substance use disorder, click on this link. Special thanks to Caroline King, Taylor Vega, Dana Button, Christina Nicolaidis, Jessica Gregg, Honora Englander and the whole Improving Addiction Care Team at Oregon Health and Science University for all of their work.