Dying of loneliness: What COVID-19 has taught us about the opioid epidemic

Opioid overdoses have been on the rise as the COVID-19 pandemic has taken center stage. Rather than existing separately, there appears to be an interplay between COVID-19 and addictions. Now, experts say the key to saving lives might be addressing the isolation brought on by the pandemic and the stigma associated with addiction.

“In this country, you have stigma and the law, and these drive people into the shadows,” said Peter Canning, a paramedic on the front lines of Connecticut’s battle against opioids.

Canning himself says he used to think addiction was a moral failing -- that is, until he actually got to know the people he helped rescue from overdose. It’s a journey he outlines in his book, "Killing Season: A Paramedic's Dispatches from the Front Lines of the Opioid Epidemic."

Meanwhile, as the pandemic raged on, loneliness and isolation began to fuel overdose deaths.

“People die from opioids when they use alone,” Canning said. “In this last year, the number of deaths has risen fairly dramatically.”

Hospital visits for opioid overdoses were 29% higher in 2020 than before the pandemic, and Canning estimates that Connecticut’s increase in opioid deaths will total roughly 17% for 2020.

COVID-19 has created an emotional burden for many -- job loss, limited recreation and canceled celebrations -- but this emotional burden was particularly devastating because it was compounded by physical isolation. For someone with an opioid use disorder, emotional burdens can be a trigger to relapse. Using alone in quarantine, without someone to identify an overdose and call 9-1-1, is a recipe for death.

In parallel, the further dissemination of synthetic opioids like fentanyl during the pandemic has claimed more lives. Now, dealers package opioids together haphazardly, mixing dangerous clumps of fentanyl unevenly with fillers, which Canning describes as "Chocolate-Chip Cookie Syndrome."

“You might get too many chocolate chips in your bag. You never know how much fentanyl you’re actually getting,” said Canning. Getting slightly more fentanyl than expected can mean the difference between life and death.

Faced with the isolation of the pandemic and the ongoing risk of fentanyl overdose, opioid users have been pushed even further into the shadows.

Canning and others like Philadelphia's public health commissioner, Dr. Thomas Farley, endorse supervised injection sites and other harm reduction strategies that allow drug users to be monitored for safety while using drugs.

Proponents of harm reduction suggest that providing clean needles and supervised injection sites keeps users alive and out of the hospital until they can attain sobriety.

Despite the growing medical consensus that opioid use disorder is a real, physical brain disease, many continue to believe addiction is a character flaw and that the only response is tough love.

But Canning says many people who become addicted fall into the exact same pattern -- a normal life, an unexpected injury, followed by an opioid prescription from a doctor that spiraled into a crippling addiction.

Instead of "punishing" those with addictions by keeping them at arms’ length, COVID-19 has reminded us that we must bring them closer, Canning says. Physical distancing saves lives, but social distancing kills them, with many addiction experts pointing to the pandemic’s hidden lesson: That loneliness kills.

Nicholas Nissen, M.D., is a clinical fellow and resident physician at Harvard Medical School and an ABC News Medical Unit Doctor.