With millions of Americans forced into weeks of extended isolation, several communities have reported a spike in drug overdose deaths, prompting health officials to raise concerns about the safety of those suffering from substance use disorders amid the COVID-19 pandemic.
In Jacksonville, Florida, the fire and rescue department reported a 20 percent increase in overdose emergency calls in March. In Columbus, Ohio, the county coroner’s office saw a surge in overdose deaths, including 12 in a 24-hour period the first week of April. And in New York State, at least four counties have acknowledged an increase in reported overdoses, including Erie County, where officials saw at least 110 drug overdoses, including 36 deaths, reported since the beginning of March.
“I think we need to consider the role that social isolation coupled with non-stop reporting on the pandemic may have on the feelings of desperation and hopelessness among those struggling with substance abuse,” U.S. Attorney for the Western District of New York James Kennedy Jr. said in a statement. “Amidst the current crisis, we need to remember that substance abuse existed long before COVID-19, and it will likely remain long after we have wiped out the virus.”
It's unclear whether the reports from local officials reflects a broader trend nationwide. The Centers for Disease Control was unable to provide national data on overdose deaths during the coronavirus crisis, but a spokesperson told ABC News its officials are “aware of the concerns involving COVID-19 and drug overdoses and that it could affect some populations with substance use disorders.”
Dr. Nora Volkow, the director of the government’s National Institute on Drug Abuse, told ABC News that the pandemic has made it difficult to collect reliable data safely.
“The problem that we are facing is that with the shutdown,” Volkow said, “our researchers cannot go into their communities, and so it is hard to obtain data.”
Health officials acknowledged there could be a myriad of potential factors behind the increase of overdoses in some communities, with a primary concern being the obstacles that social distancing orders have created for public health services like addiction clinics and syringe exchange services.
While those suffering from heroin and opioid use disorder typically have to visit clinics on a daily basis to receive addiction treatment resources and medications like methadone, many facilities have been forced to restrict access or operate with reduced staffing. In an effort to assist those groups, the Department of Health and Human Services have relaxed rules that allowed substance users to take home as much as four weeks-worth of such medications.
Steve Alsum, the executive director of the Red Project in Grand Rapids, Michigan, which provides addiction treatment services, told ABC New he has expanded hours and adjusted operations by facilitating call-in orders that workers place outside the clinic’s doors to avoid social contact.
In another major effort aimed at reducing overdose deaths amid the public health crisis, local officials have sought to maximize distribution of Naloxone, or Narcan, to communities, which has emerged as a lifesaving tool in the opioid epidemic.
According to Jamie Favaro, the founder of Next Harm Reduction, which provides naloxone via mail for people who use drugs or individuals who may be first responders, her group saw a 300 percent increase just last month in their online reporting system for overdoses.
“They’re just streaming in,” Favaro said.
Officials expressed concern, however, that the surge in Narcan use may not tell the full story regarding overdoses.
“If you think about it, we advise people who use [drugs] to use with someone else who is carrying Narcan,” said Dr. Anahi Ortiz, the coroner for Franklin County, Ohio. “Well they can’t do that now if they want to be safe against COVID-19. So they’re using in solitary, so there’s no one there to administer Narcan.”
Restrictions on movement may also lead those with substance abuse disorder to opt to purchase heroin or opioids from less trusted sources, officials say, raising the risk of overdosing on drugs that may be spiked or tainted.
“If you're a person addicted to an opioid, and you cannot find drugs, you get desperate and you do very risky behaviors,” Dr. Volkow said. “I mean, that is likely to be one of the consequences of people that need that drug -- so the body's experienced it as a need so if they don't get it, they'll actually consume something that otherwise they wouldn't have if they had choices.”
Further complicating the problem, some first responders are exhibiting greater caution when responding to emergency calls.
In Lawrence, Indiana, a suburb of Indianapolis, for example, Chief of Police David Hofmann took the extraordinary step of issuing a directive to his officers to not administer Narcan in response calls for overdoses out of concern that upon recovery individuals who may have COVID-19 could transmit it.
Instead, Hofmann told ABC News, officers are told to remain at least six feet away from unconscious subjects and wait for responders in proper medical protective gear to arrive to the scene, a span of time that could he is fully aware could mean the difference between life and death.
“My officers, I think they understand the gravity of it,” Hofmann said. “You know, they raised their right hand and took an oath to God that they would protect human life and this directive on its face goes against that. But if you look deeper, it actually protects the human life of the officer.”
With continued uncertainty in just how long lockdown orders could remain, officials say that a key effort to limiting overdoses will be addressing the overarching vulnerability in communities suffering from substance abuse disorder: isolation.
“The stressors from the pandemic are very, very real and how we cope with these stressors varies enormously,” Dr. Volkow said. “Social isolation is one of the factors that leads them to take drugs, and social isolation leads them to relapse, and the social isolation leads them to continue taking them.”
Dr. Volkow highlighted the efforts of local groups taking the advantage of virtual technologies to connect with users through groups like Narcotics Anonymous as well as shelter facilities who have continued intake efforts while implementing safeguards to protect residents' health.
“Being able to provide social support in an era of social distancing is fundamental,” Dr. Volkow said. “What we do know that has helped all along are community programs that are able to provide a sense of belonging and a meaningful belonging to your group.”