Opioid and stimulant use is on the rise—how can psychologists and other clinicians help a greater number of patients struggling with drug use?
By Ashley Abramson Date created: March 1, 2021 8 min read
Vol. 52 No. 2
Print version: page 22
- Substance Use, Abuse, and Addiction
Cite this
Abramson, A. (2021, March 1). Substance use during the pandemic. Monitor on Psychology, 52(2). https://www.apa.org/monitor/2021/03/substance-use-pandemic
The ongoing stress and uncertainty of COVID-19 have led to increased demand for mental health services from psychologists in the United States—but conditions like anxiety and depression aren’t the only mental health issues people are facing. Experts say misuse of opioids and stimulants is also on the rise—and psychologists are in a good position to help.
On top of the other risks arising with substance misuse, those with substance use disorders (SUD) are both more likely to develop COVID-19 and experience worse COVID-19 outcomes, including higher risk of hospitalization and mortality (Wang, Q., et al., Molecular Psychiatry, 2020).
According to the Centers for Disease Control and Prevention, as of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. Overdoses have also spiked since the onset of the pandemic. A reporting system called ODMAP shows that the early months of the pandemic brought an 18% increase nationwide in overdoses compared with those same months in 2019. The trend has continued throughout 2020, according to the American Medical Association, which reported in December that more than 40 U.S. states have seen increases in opioid-related mortality along with ongoing concerns for those with substance use disorders.
Mandy Owens, PhD, a clinical psychologist and researcher at the University of Washington Alcohol and Drug Abuse Institute, says she’s observed a spike in substance use that includes an increase in both quantity and frequency of drug use during the pandemic. Some people who use substances may have also started new drugs if their usual substances became more difficult to access. For example, Owens says Washington state has seen an uptick in the use of fentanyl, a synthetic opioid that’s increasingly produced illicitly, due to a shift in drug supply availability. But precise data on use and drug type are hard to come by, according to Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse.
Health care records are the primary source of data on substance use, and it can take months for medical providers to provide toxicology reports for overdose incidents to the CDC, says Sharon Walsh, PhD, a professor of behavioral science, pharmacology, pharmaceutical sciences, and psychiatry at the University of Kentucky (UK) and director of the UK Center on Drug and Alcohol Research. Tracking substance use accurately also heavily depends on the ability to do door-to-door household or school-based surveys, which have been more difficult to conduct during the pandemic.
However, Walsh says state-level data are a bit clearer. According to her research, Kentucky has seen increased emergency room visits for overdose-related incidents during the pandemic. By contrast, the state experienced a decline in emergency medical service runs for non-opioid related emergencies. “It really magnifies the opioid problem when you look at it against a decline in presentation at the hospital for other conditions,” she says.
The relationship between the pandemic and drug use
Compton cautions against conflating all increased drug use directly with COVID-19. For example, shifts in drug availability may also be to blame for increased illicit opioid use deaths; if heroin isn’t easy to access, someone might take fentanyl, which is much stronger. But experts agree based on research and clinical observation that pandemic-related strains, from economic stress and loneliness to general anxiety about the virus, are a major driver for the increase. “There’s sort of a perfect storm of factors that we know increase drug use,” says William Stoops, PhD, a professor of behavioral science, psychiatry and psychology at the University of Kentucky. “People are more stressed and isolated, so they make unhealthy decisions, including drinking more and taking drugs.” (See January Monitor for more on drinking habits during COVID-19.)
As their stress increases, people may have fewer ways to manage it, which Owens says probably contributes to the uptick in substance misuse. For example, resilience-promoting activities, like physical activity and social interactions, haven’t been as safe to engage in or easy to access, which can lead some people to start using drugs or use them more often or in greater amounts.
There are also practical pandemic-related reasons for the rise in overdoses. Compton says people are more likely to die when they are using drugs alone, because there’s no one there to call 911 or administer naloxone, an opioid-reversal agent. For those living alone during the pandemic, this isolation presents an obvious risk. And in the early part of the pandemic, it was more difficult for people to seek the medical care they needed for recovery from opioid use because some clinics and community-based organizations decreased their services.
Walsh says that in March and April, Kentucky methadone clinics saw an increase in patients ending treatment and a decrease in new patients starting treatment. “Physicians have been concentrating largely on COVID-19, and medical systems are overwhelmed, so people can’t always access the care they need,” says Stoops. “There’s also a stigma around substance use disorder that keeps people away from treatment, and even more so during a pandemic.”
A shift toward telemedicine
Fortunately, it’s become easier throughout the pandemic for people to access care for substance use disorders, thanks to the increased availability of telemedicine for behavioral health concerns. While the pandemic initially caused many clinics and community-based organizations to close their doors, telehealth options for physical and mental health problems have become increasingly available as insurance providers and organizations have recognized the need. In addition, it’s becoming more common for community-based groups like Narcotics Anonymous and Alcoholics Anonymous to meet virtually. And most insurers, including Medicaid, have lifted previous telehealth restrictions on treatment for behavioral health, including substance use disorder.
For example, Compton says physicians can now start patients on buprenorphine, a drug used for opioid recovery, through telehealth without conducting an in-person exam. Opioid Treatment Program providers (at so-called “methadone clinics”) have also been offering patients take-home methadone for maintenance more frequently during the pandemic. “Normally you have to be extraordinarily stable to take as many as 30 doses at a time home, but they’ve relaxed some of those [requirements] so patients don’t have to show up every day to an opioid treatment program,” Compton says.
Better access to telehealth means people with substance use issues can also seek remote mental health care. While Owens says accessing treatment can be difficult for people without reliable internet or phone service, according to Compton, clinicians are largely reporting more patients showing up for psychotherapy appointments thanks to the increasing use of telehealth. “One clear benefit of changes in treatment infrastructure throughout the pandemic is that the availability of telehealth may have helped some folks that were on the precipice of seeking help go seek that help,” says Justin Strickland, PhD, a postdoctoral fellow in behavioral pharmacology at the Johns Hopkins University School of Medicine.
What psychologists can do to help
Psychologists are well positioned to support patients struggling with substance use disorders. But how they help their patients depends on the type of drug. For opioid use disorder, medications like buprenorphine are a key component of treatment. Owens says encouraging patients to seek medical treatment is the first step to preventing long-term impact of opioid use, including overdose. Concurrent psychological treatment can help people adhere to the medication schedule, identify and respond in more healthy ways to stressors that have led them to opioid use, and address related conditions such as pain, post-traumatic stress, anxiety, and depression.
According to Paul Christo, MD, an associate professor in the Division of Pain Medicine at the Johns Hopkins University School of Medicine, it’s also important for psychologists to advocate for expanded availability of naloxone, which, in certain states, anyone can request from a pharmacy to have on hand to treat narcotic overdose in emergencies. “We need greater awareness around the country that this is something that can prevent someone from dying,” Christo says.
There’s no FDA-approved medication physicians can use to help patients recover from use of stimulants, such as cocaine and methamphetamine, but Stoops says there are a number of behavior-based interventions, such as cognitive behavioral therapy (CBT), that psychologists can use to help. Some clinicians couple CBT with an approach called contingency management, which promotes abstinence by providing alternative reinforcers like gift cards or vouchers when patients show they have not used drugs.
Psychologists should also make a habit of asking all their patients about any substance use. Owens encourages clinicians not to assume patients without a SUD diagnosis aren’t misusing substances or at risk for misuse in the future. “As stressors have continued and effective coping skills have been cut off, it’s more likely for people to turn to substances,” she says.
If a patient says they have been using, Owens encourages clinicians to extend compassion, with the goal of helping patients understand how compounding stressors may be influencing their substance use and identify better ways to cope. “Instead of assuming people want to quit using, psychologists should help patients do a functional analysis of the substance’s role in their lives,” she says.
It’s also important, Owens says, to recognize that weekly outpatient appointments might not be enough for every patient, especially those with more free time on their hands during the pandemic. Psychologists should coordinate care with other providers as needed, focusing on adding as much structure and support to their patients’ routine as possible. For example, Owens treats a patient with a SUD in an outpatient setting once weekly, but the patient also participates in intensive outpatient care through another local provider. Psychologists should also consider encouraging patients to participate in virtual community support groups, adds Owens. There’s no black-and-white approach to helping patients struggling with substance use, she says. “It’s really about tailoring to what each patient needs.”
Resources
Collision of SUD and COVID-19: A NIDA update
NAADAC, the Association for Addiction Professionals, 2020
Mental health and substance use disorders in the era of COVID-19: With a special focus on the impact of the pandemic on communities of color: A workshop
National Academies of Sciences, Engineering, and Medicine, 2020
Special report: New solutions for the opioid crisis
Monitor, June 2019
Related and recent
Abramson, A. (2021, March 1). Substance use during the pandemic. Monitor on Psychology, 52(2). https://www.apa.org/monitor/2021/03/substance-use-pandemic
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FAQs
Has substance use risen during the COVID pandemic? ›
According to the Centers for Disease Control and Prevention (CDC), 13% of Americans have reported increasing or starting substance use as a way of coping with stress related to the pandemic2. An overdose reporting system known as ODMAP also reported an 18% increase nationwide in opiate overdoses2.
Are people with substance use disorder more vulnerable to Covid 19? ›Yes. Substance use disorders are considered underlying medical conditions that increase the risk of serious, life-threatening complications from COVID-19. COVID-19 vaccinations are recommended for and can be administered to most people with underlying conditions.
Why is prescription drug abuse on the rise? ›Why Is Prescription Drug Abuse on the Rise? Some experts think that more people are abusing prescription medications because there are more drugs available. Doctors report writing more prescriptions than ever before. Also, it's easy to find online pharmacies selling these drugs.
What are substance use disorders? ›Substance Use Disorders (SUDs) are treatable, chronic diseases characterized by a problematic pattern of use of a substance or substances leading to impairments in health, social function, and control over substance use.
How the pandemic has affected mental health? ›Information overload, rumors and misinformation can make your life feel out of control and make it unclear what to do. During the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness. And mental health disorders, including anxiety and depression, can worsen.
What drugs are on the market for COVID? ›- REGEN-COV (casirivimab and imdevimab)
- Sotrovimab.
- Bamlanivimab and Etesevimab.
- Bebtelovimab.
- Evusheld (tixagevimab co-packaged with cilgavimab)
- Family history of substance use.
- Favorable parental attitudes towards the behavior.
- Poor parental monitoring.
- Parental substance use.
- Family rejection of sexual orientation or gender identity.
- Association with delinquent or substance using peers.
- Lack of school connectedness.
People who have experienced physical, emotional or sexual abuse or trauma are more likely to develop a substance use disorder. Others who have friends who use, or those subjected to peer pressure, may also be at a greater risk.
What group is most affected by coronavirus? ›Older adults are at highest risk of getting very sick from COVID-19. More than 81% of COVID-19 deaths occur in people over age 65. The number of deaths among people over age 65 is 97 times higher than the number of deaths among people ages 18-29 years.
What are the two most commonly abused prescription drugs? ›Three types of drugs are abused most often: • Opioids—prescribed for pain relief • CNS depressants—barbiturates and benzodiazepines prescribed for anxiety or sleep problems (often referred to as sedatives or tranquilizers) • Stimulants—prescribed for attention-deficit hyperactivity disorder (ADHD), the sleep disorder ...
Has opioid prescribing decreased? ›
The number of Medicaid prescriptions for opioids in this analysis declined by 27% from 2016 to 2019, driven by a decline in the number of opioid prescriptions used to treat pain. The utilization of opioids prescriptions to treat pain declined by 44% from 2016 to 2019 (Figure 1).
What percentage of Americans rely on prescription drugs? ›Recent CivicScience poll results reveal the picture of maintenance prescription drug use in the U.S. has shifted dramatically. The number of U.S. adults who report taking at least one prescription medication per day is now 70%, a 14 percentage-point increase from 2019 data.
What are the 6 types of substance abuse? ›There are a wide variety of addictive substances that exist, but the most common types are classified under 6 main categories: alcohol, Benzodiazepines, illicit drugs, Opiates, Sleeping Pills, and Stimulants.
What is the most common substance use disorder in the United States? ›Alcohol use disorder is still the most common form of substance use disorder in America, fueled by widespread legal access and social approval of moderate drinking.
What are 3 substance use disorders? ›- Alcohol use disorder.
- Cannabis use disorder, also known as marijuana use disorder.
- Phencyclidine use disorder, a type of hallucinogen.
- Other hallucinogen-use disorder, which includes hallucinogens other than phencyclidine.
- Inhalant use disorder.
- Opioid use disorder.
Mental illness has risen in the United States, with about 20% of people in the country experiencing some form of it. The increase is due to the rise in social media, the COVID-19 pandemic, and societal trends that have resulted in smaller family units and less community involvement.
Can COVID make bipolar worse? ›Results have shown that COVID-19 may trigger a pre-existing bipolar disorder or unmask an unknown BD, due to social and psychological influences and through biological pathways both.
How does COVID-19 affect psychological wellbeing? ›Finally, confirming that the COVID-19 pandemic has caused worldwide physical but also psychological health issues, systematic reviews and meta-analyses reported significant higher levels of depression, anxiety, insomnia, post-traumatic stress disorder and psychological distress as short-term consequences of the COVID- ...
What is the number one drug for COVID? ›The FDA has approved an antiviral drug called remdesivir (Veklury) to treat COVID-19 in adults and children who are age 12 and older. Remdesivir may be prescribed for people who are hospitalized with COVID-19 and need supplemental oxygen or have a higher risk of serious illness.
What are the best drugs to combat COVID? ›You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better.
What is the most effective drug for COVID-19? ›
Paxlovid is an antiviral drug that is most effective when started as soon as possible after testing positive for COVID-19, and no later than five days after the onset of symptoms. The drug is authorized for emergency use by the FDA for people 12 years and older who are at increased risk for severe illness.
What are symptoms of addiction? ›Signs of drug addiction include frequent intoxication, hangover or illness, and paraphernalia related to substance abuse. Behavioral changes may also indicate drug or alcohol addiction, and these include: Problems at work or school, including poor performance, lateness or absenteeism, and social dysfunction.
Which factors may increase the likelihood of a person using drugs? ›Factors such as peer pressure, physical and sexual abuse, early exposure to drugs, stress, and parental guidance can greatly affect a person's likelihood of drug use and addiction. Development. Genetic and environmental factors interact with critical developmental stages in a person's life to affect addiction risk.
What type of psychiatric disorder has the highest risk for substance use? ›Patients with schizophrenia have higher rates of alcohol, tobacco, and drug use disorders than the general population.
What are the two types of substance abuse? ›There are two main types of substance use disorders: alcohol use disorder and drug use disorder. Some people abuse both substances, while others are addicted to one or the other.
What are the predictors of drug abuse? ›Highlights. Addictive disorders are predicted by a unique combination of psychosocial factors. These include personality traits, family environment, and negative life events. Higher impulsivity and more negative life events predicted all addictive disorders.
What percentage of the population has an addictive personality? ›It is estimated that 10-15% of the population has an addictive personality. This percentage of the population doesn't know when to stop and has a more difficult time coping with drugs and alcohol. If you think you or a loved one may have an addictive personality, consider the following addictive personality traits.
How does COVID affect the brain? ›When people first become sick from the virus, they may develop encephalitis — inflammation of the brain — causing confusion, difficulty concentrating, and memory problems. COVID also can trigger the onset of new psychological disorders such as severe depression or anxiety.
What organs does COVID damage? ›The virus can also increase the likelihood of dangerous blood clots in the heart, lungs, legs, liver, and kidneys. It is recommended that those with COVID-19 are closely monitored after their recovery for any complications related to organ damage.
What part of the body does Covid affect? ›Although COVID-19 is a respiratory disease, meaning it primarily impacts the lungs, it has been shown to affect organs and functions throughout the body. And while most people experience mild to moderate symptoms from COVID-19, the disease can have severe impacts.
What is the #1 prescribed drug? ›
| Rank | Drug Name | Total Prescriptions (2020) |
|---|---|---|
| 1 | Atorvastatin | 114,509,814 |
| 2 | Levothyroxine | 98,970,640 |
| 3 | Metformin | 92,591,486 |
| 4 | Lisinopril | 88,597,017 |
- Adderall.
- Concerta.
- Dexedrine.
- Ritalin.
- Vyvanse.
- Top 10.
- Lisinopril.
- Levothyroxine.
- Atorvastatin.
- Metformin.
- Simvastatin.
- Omeprazole.
- Amlodipine.
There is a wide variation of opioid prescription rates across states. Health care providers in the highest prescribing state, Alabama, wrote almost three times as many of these prescriptions per person as those in the lowest prescribing state, Hawaii.
Why don t doctors prescribe opioids anymore? ›Opioid medications have long been prescribed to help people manage their chronic pain and live productive lives. However, the rising tide of the opioid crisis has led to concerns that opioids are over-prescribed. This has led some doctors to stop prescribing pain medication to patients who need it. We break down why.
Do doctors make money from prescribing opioids? ›Doctors were more likely to get paid by drug companies if they prescribed a lot of opioids – and they were more likely to get paid a lot of money. Among doctors in the top 25th percentile of opioid prescribers by volume, 72% received payments. Among those in the top fifth percentile, 84% received payments.
What country takes the most prescription drugs? ›- Data suggests that among those who take prescription medications, the average number of medications taken is four. ...
- Research on prescription drug spending suggests that the United States consumes the most prescription drugs.
About 130 million Americans — many far healthier than the Heckmans — swallow, inject, inhale, infuse, spray, and pat on prescribed medication every month, the U.S. Centers for Disease Control and Prevention indicates. Americans buy much more medicine per person than any other country.
Why do American doctors prescribe so many drugs? ›Many Americans and their doctors feel that every symptom or even a hint of a disease requires a drug to treat it. As sad as that sounds, this is the culture we live in. Even health insurance companies find prescriptions the easiest and least expensive way to address a patient's health.
Is OxyContin still available? ›What is OxyContin? OxyContin, a trade name for the narcotic oxycodone hydrochloride, is a painkiller available in the United States only by prescription.
What is a major substance of abuse? ›
Substances frequently include: Alcohol. Marijuana. Prescription medicines, such as pain pills, stimulants, or anxiety pills.
Which type of drug may lead to a user crashing? ›Amphetamine use can also impair judgement and contribute to accidents and injury (such as motor vehicle crashes).
What is the most severe form of a substance use disorder? ›Substance use disorder (SUD) is a treatable mental disorder that affects a person's brain and behavior, leading to their inability to control their use of substances like legal or illegal drugs, alcohol, or medications. Symptoms can be moderate to severe, with addiction being the most severe form of SUD.
What is the most common type of treatment for a substance use disorder? ›Behavioral therapy is perhaps the most commonly utilized types of treatment for addiction that is frequently used during substance rehabilitation. A general behavioral therapeutic approach has been adapted into a variety of effective techniques.
How does addiction affect the brain? ›Drugs interfere with the way neurons send, receive, and process signals via neurotransmitters. Some drugs, such as marijuana and heroin, can activate neurons because their chemical structure mimics that of a natural neurotransmitter in the body.
What drugs cause personality changes? ›These include methamphetamine, MDMA (ecstasy or Molly), LSD, and certain prescription medications. When taken in large doses, these substances can alter your mood, behavior, and even your identity. In some cases, long-term use of such drugs can result in permanent changes to one's personality.
What are the psychological causes of addiction? ›A person's genes, the action of the drug, peer pressure, emotional distress, anxiety, depression, and environmental stress can all be factors. Many who develop a substance use problem have depression, attention deficit disorder, post-traumatic stress disorder, or another mental problem.
What is another word for substance abuse? ›| Instead of… | Use... |
|---|---|
| Habit | Substance use disorder Drug addiction |
| Abuse | For illicit drugs: Use For prescription medications: Misuse Used other than prescribed |
Behavioral changes shifted fast when the pandemic began, such as social distancing, masking and isolation from others. Mitigation efforts created weak social ties that affected communications and trust.
What repurposed drug is being used on COVID-19 patients? ›A trial that evaluated 3 existing generic medications—metformin, ivermectin, and fluvoxamine—for early outpatient treatment of SARS-CoV-2 infection among adults with overweight and obesity did not prevent progression to severe COVID-19.
What is the new drug discovery for COVID-19? ›
Lopinavir and ritonavir were the first drugs used in clinical trials to treat COVID-19 targeting Mpro (Cao et al., 2020). They are inhibitors to human immunodeficiency virus (HIV) aspartyl protease, which is encoded by the pol gene of HIV and cleaves the precursor polypeptides in HIV (Walmsley et al., 2002).
Are there drugs to lessen the effects of COVID? ›You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better.
What are the most affected by the COVID-19 pandemic? ›Older age. People of any age can catch COVID-19 . But it most commonly affects middle-aged and older adults. The risk of developing dangerous symptoms increases with age, with those who are age 85 and older are at the highest risk of serious symptoms.
What are the negative effects of COVID-19 pandemic? ›Facility closures, social isolation, and quarantine have caused a loss of social connection with teachers, friends, and peers. Decreased physical activity, loss of tutor time, and increased 'screen time' through virtual learning, social or digital media can adversely affect mental health.
What are the problems caused by Covid? ›Early symptoms of COVID-19 may include a loss of taste or smell. Other symptoms can include: Shortness of breath or difficulty breathing. Muscle aches.
What is the COVID drug Paxlovid? ›Paxlovid (nirmatrelvir co-packaged with ritonavir) is an oral antiviral drug that should be initiated as soon as possible within 5 days of symptom onset. Paxlovid is available for patients by prescription only.
Is remdesivir a drug? ›Remdesivir is an antiviral medicine that works against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This medicine is to be given only by or under the immediate supervision of your doctor. This product is available in the following dosage forms: Solution.
What is the name of the new Covid antiviral drug? ›Remdesivir is the only antiviral drug that is approved by the Food and Drug Administration (FDA) for the treatment of COVID-19.
What drug did Merck treat COVID-19? ›Molnupiravir (MK-4482) is an investigational, orally administered nucleoside analog that inhibits the replication of SARS-CoV-2, the causative agent of COVID-19.
What is Molnupiravir? ›Molnupiravir, sold under the brand name Lagevrio, is an antiviral medication that inhibits the replication of certain RNA viruses. It is used to treat COVID-19 in those infected by SARS-CoV-2.
Who should not take hydroxychloroquine? ›
Drugs that affect heart rhythm
Hydroxychloroquine should not be taken with other drugs that could cause heart arrhythmias (irregular heart rate or rhythm). Taking hydroxychloroquine with these drugs could cause dangerous arrhythmias. Examples of these drugs include: amiodarone.
People with moderate or severe COVID-19 should isolate through at least day 10. Those with severe COVID-19 may remain infectious beyond 10 days and may need to extend isolation for up to 20 days.
Does mucinex help with COVID? ›Over-the-counter medications used for upper respiratory infections may help alleviate symptoms. Those medications include guaifenesin (Mucinex), pseudoephedrine (Sudafed), and dextromethorphan (Robitussin, Delsym).