Substance use problems in the U.S. exacerbated by pandemic, studies indicate

Two recent studies described how COVID-19 has exacerbated substance use problems.

One analysis, published as a research letter by JAMA on Sept. 18, compared a random sample of 75,000 urine drug tests taken before COVID-19 with 75,000 taken from March 13 to July 10. It found that the proportion of specimens testing positive increased from 3.59% to 4.76% for cocaine, from 3.80% to 7.32% for fentanyl, from 1.29% to 2.09% for heroin, and from 5.89% to 8.16% for methamphetamine. The authors cautioned that the study had limitations, including that patients being tested during the pandemic may be at inherently higher risk, but concluded that urine drug test positivity increased significantly for all of the studied drugs in a population with or at risk of substance use disorders.

Another study, also published as a research letter by JAMA on Sept. 18, looked at nonfatal opioid overdose visits to a single ED in Virginia. They increased from 102 between March and June 2019 to 227 between March and June 2020. In addition to the overall increase, the study found that a higher proportion of overdose patients were Black in 2020 (63% vs. 80%). Slightly more than half of the patients received a naloxone prescription in either period, and 44% of 2019 patients and 68% of 2020 patients received treatment resources and/or a referral at discharge. However, less than a tenth of the admitted patients received an addiction medicine consult in either time period.

Taken together, the studies “suggest that substance use and opioid overdoses in the COVID-19 era may be increasing, consistent with media reports,” said an accompanying editorial. It noted that recent pandemic-motivated policy changes, including expanding Medicaid, easing restrictions on methadone dispensing, and allowing more telemedicine, could help, but more efforts will be needed.