Avery Marti, Author at Aspenti

The intersection of COVID-19 and the opioid epidemic put the American healthcare system in a challenging position. Cases surge throughout the country, forcing hospitals to focus on the immediate public health threat of COVID-19 rather than other ongoing public health concerns. Despite declining media coverage of the opioid epidemic, studies show an increase in substance use since late March of 2020 indicating a worsening of the epidemic. The American Medical Association attributes social distancing, a dramatic increase in unemployment, and widespread economic deterioration to the overall increase in feelings of isolation and anxiety, which are common triggers of substance use disorders. Beyond that, COVID-19 presents a unique set of challenges for those in recovery; treatment centers, and outpatient services operate differently if at all due to social distancing guidelines.

Another major cultural shift results from the lack of a unified response to COVID-19 from the US federal government; American citizens continue to lose their jobs. Preliminary research shows that unemployment is one of the largest contributors to the increase in substance use disorders during COVID-19. Daniel Buccino of the Johns Hopkins Broadway Center for Addiction writes, “At first, some of our patients were resilient and resourceful in staying drug-free. As time went on, it started getting harder for them” (Winer 2020).

Unemployment has increased dramatically due to COVID-19, but the issue has been tied to opioid use before COVID-19. Research conducted in 2017 by economists at the National Bureau of Economic Research found that “As the county unemployment rate increases by one percentage point, the opioid death rate per 100,000 rises by 0.19 (3.6%) and the opioid overdose ED visit rate per 100,000 increases by 0.95 (7.0%)” (Hollingsworth, Ruhm and Simon 2017). Macroeconomic shock affects opioid use in “normal” times making the COVID-19 pandemic a perfect storm as it brings economic downturn and mass unemployment coupled with isolation and uncertainty. Coupled with a lack of access to care due to the stress on the health system from the immediate threat of the virus, those in recovery from a substance use disorder find themselves in an exceptionally challenging position.

The solution is twofold. First, healthcare providers need to innovate in order to reach struggling patients. Solutions like Aspenti’s mobile health unit allow healthcare professionals to reach the most vulnerable population without putting themselves or their patients at risk. Second, economic relief provided by the federal government and an expansion of unemployment benefits are crucial resources for the health of the population in these challenging times. Solutions to the pandemic and opioid epidemic are complex and intersected, but until the economic recession due to COVID-19 subsides, it is more difficult than ever for those with a history of substance use to improve their situation.

Hollingsworth, A., Ruhmn, C., and Simon, K. (2017). MACROECONOMIC CONDITIONS AND OPIOID ABUSE. National Bureau of Economic Research. https://www.nber.org/papers/w23192.pdf

Devivo, A. (2020). Aspenti Health™ launches a Mobile Unit for Urine Drug Testing Collections. https://aspenti.com/aspenti-health-launches-a-mobile-unit-for-urine-drug-testing-collections/

Robezieks, A. (2020). COVID-19 may be worsening opioid crisis, but states can take action. https://www.ama-assn.org/delivering-care/opioids/covid-19-may-be-worsening-opioid-crisis-states-can-take-action

Weiner, S. (2020). COVID-19 and the opioid crisis: When a pandemic and an epidemic collide. https://www.aamc.org/news-insights/covid-19-and-opioid-crisis-when-pandemic-and-epidemic-collide

As COVID-19 continues to plague the United States, cases are documented on a state by state basis. Native Americans and Alaskans are both underrepresented in the media coverage of the COVID-19 pandemic and have disproportionately high cases on their sovereign lands. As of July 12, the Navajo Nation in Oaklahoma had 8,187 cases of COVID-19, 401 of which resulted in death. The Navajo Nation has the highest cases per-100 people in the United States.

The pandemic surges in these vulnerable communities at a time when they face another major health crisis, the opioid epidemic. According to the National Indian Health Board, “American Indians and Alaska Natives face opioid-related fatalities at three times the rate for Blacks and Hispanic Whites” (National Indian Health Board). The high fatality rates compared to other races can be attributed to the lack of medical care and funding on these reservations. Tribal nations are regularly excluded from public-funded health initiatives, so while a state may allocate resources to combat the epidemic, sovereign nations do not receive those resources. And while sovereign nations lack access recovery resources, they do not lack access to the drugs themselves.

According to an analysis of the Drug Enforcement Administration database, “Opioid distributors shipped an average of 57 pills per person per year to Oklahoma from 2006 to 2014. That’s far higher than the national average of 36 and just under the number of pills shipped to states in the opioid belt in and around Appalachia…At least 370 Native Americans in Oklahoma overdosed and died — with a death rate roughly equivalent to that of West Virginia” (Horwitz et al 2020).

The COVID-19 pandemic presents a similar set of challenges for sovereign nations, they lack federal support from the state they reside in, despite identical challenges faced. Many lawyers across the country represent sovereign nations and demand justice for these communities both for the mistreatment throughout their challenges with the opioid epidemic and the disproportionately high cases and deaths of COVID-19. Lloyd Miller, a lawyer representing Oaklahoma tribes writes, “The opioid crisis devastated Indian country by every measure. So did lung cancer. But when the tobacco litigation was all wrapped up, not a dime was allocated to tribal governments to deal with the devastation that cancer had left behind and the addiction issues. That will not be repeated” (Horwitz et al 2020).

Find more resources about the effects of the COIVD-19 pandemic and opioid epidemic on sovereign nations below:

Hlavinka, E. (2020). COVID-19 Further Strains Care Disparities Among Native Americans. https://www.medpagetoday.com/infectiousdisease/covid19/86633

Horwitz, S., Cenziper, D., and Rich, S. (2020). As opioids flooded tribal lands across the U.S., overdose deaths skyrocketed. https://www.washingtonpost.com/graphics/2020/national/investigations/native-american-opioid-overdose-deaths/

Indian Health Service. (2019). Opioid Crisis Data: Understanding the Epidemic. https://www.ihs.gov/opioids/data/

National Indian Health Board. (2020). Addressing the Opioid Epidemic in American Indian and Alaska Native Communities. https://www.nihb.org/docs/09182017/Opioids%20One%20pager.PDF

Pinon, N. (2020). Native American communities are struggling during the pandemic. Here's how to help. https://mashable.com/article/how-to-help-native-american-communities-coronavirus/

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Hollingsworth, A., Ruhmn, C., and Simon, K. (2017). MACROECONOMIC CONDITIONS AND OPIOID ABUSE. National Bureau of Economic Research. https://www.nber.org/papers/w23192.pdf

Devivo, A. (2020). Aspenti Health™ launches a Mobile Unit for Urine Drug Testing Collections. https://aspenti.com/aspenti-health-launches-a-mobile-unit-for-urine-drug-testing-collections/

Weiner, S. (2020). COVID-19 and the opioid crisis: When a pandemic and an epidemic collide. https://www.aamc.org/news-insights/covid-19-and-opioid-crisis-when-pandemic-and-epidemic-collide

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Author: Avery Marti

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