The COVID-19 pandemic has disrupted the lives of people who use drugs in ways that harm their mental health and changed drug-using behaviors, increasing their risk of overdose, according to surveys and interviews with experts. rural Illinois people captured in a new study in Addiction science and clinical practice.
Drug overdoses have soared during the COVID-19 pandemic, with overdose deaths in the United States exceeding 100,000 in the 12 months ending April 2021. Researchers are beginning to unravel how the pandemic and strategies to prevent the spread of the virus, such as stay-at-home orders, may have contributed to this increase in deaths, from disruptions in harm reduction programs to isolation and worsening health mental.
People who use drugs and live in rural areas may be disproportionately affected by the changes brought about during the pandemic, given that many rural areas have higher rates of opioid and methamphetamine use and already have limited drug treatment and harm reduction services. People who use drugs in rural areas may also experience higher levels of stigma regarding their drug use, which may contribute to a greater likelihood of using drugs alone and a reluctance to seek medical attention.
In a series of surveys and interviews with people who use drugs in rural southern Illinois, researchers sought to understand their experiences during the COVID-19 pandemic and how structural and community-level disruptions could affect an individual’s risk of overdose. Between August 2020 and May 2021, researchers conducted surveys of 50 people who use opioids (without a prescription) or inject drugs, and conducted in-depth interviews with a subset of 17 participants.
“We know there has been a tragic increase in overdose deaths during the pandemic. Our study provides insight into Why et comment there have been more overdose deaths,” said Suzan Walters, assistant research professor at the NYU School of Global Public Health and researcher at NYU’s Center for Drug Use and HIV/HCV Research (CDUHR).
Like the general population, people who use drugs have reported worsening economic conditions – in a region already plagued by widespread poverty – and mental health during the pandemic. Only 38% of participants were confident they could maintain a stable income during the pandemic, thanks to layoffs, disruptions to their work in service industries and fewer available jobs. Additionally, participants reported that the pandemic has exacerbated food and housing insecurity.
A significant proportion of participants said their mental well-being had suffered: three-quarters of survey respondents felt more anxious or nervous during the pandemic, more than half felt more depressed, and nearly half felt more alone. Anxiety and depression are associated with increased substance use, which in turn can increase the risk of overdose.
Participants also described how the pandemic has changed their daily drug use behaviors. Two-thirds of respondents said the process of obtaining medicine was more difficult during the pandemic, and more than half feared they might end up with the wrong batch of medicine in the near future that would be dangerous. Notably, half of survey respondents said they are currently more likely to use drugs alone than before the pandemic, which may increase the risk of overdose.
Interviews revealed an emerging trend of consuming fentanyl “beans” or “buttons,” which were described as small capsules filled with fentanyl. Participants said fentanyl was cheaper and more readily available than heroin, which has become harder to obtain during the pandemic.
“Our findings suggest that structural and community issues during the pandemic increased anxiety, depression, and loneliness at the individual level. increase the risk of overdose,” said Walters, who is also an affiliate professor at the Center for Opioid Epidemiology and Policy (COEP) at NYU Langone.
To prevent overdoses, the researchers recommend not only ensuring access to resources and services at the individual level, but also addressing broader systemic and community issues, including increased access to economic opportunities and reduced stigma associated with drug use.
Other study authors include Rebecca Bolinski, Stacy Grundy, and Wiley Jenkins of Southern Illinois University; Ellen Almirol, John Schneider and Mai Pho of the University of Chicago; Scott Felsher of Community Action Place, Inc.; Samuel Friedman of CDUHR and NYU Grossman School of Medicine; Lawrence Ouellet of the University of Illinois at Chicago; and Danielle Ompad of CDUHR and the NYU School of Global Public Health.