Recent data on overdose deaths and substance use paint a grim picture of what the COVID-19 pandemic year has been like for people who are predisposed to substance use.

Nationally, there were 87,000 drug overdose deaths between October 2019 and September 2020, according to data from the US Centers for Disease Control and Prevention (CDC).

In San Francisco, twice as many deaths were caused by drug overdoses as COVID-19 between June and November 2020, as Thomas Fuller reported in the New York Times.

While some of the early data on overdose deaths (both nationally and in San Francisco) precede the start of the pandemic, anecdotal evidence suggests that many people increased their use of substances during the pandemic. “The biggest jump in overdose deaths took place in April and May [2020], when fear and stress were rampant, job losses were multiplying, and the strictest lockdown measures were in effect,” reporter Abby Goodnough noted in the New York Times.

Overdose deaths had dipped in 2018, then began climbing again in 2019. The pandemic appears to be driving more use; addiction experts say that people have turned to substances to cope with the anxiety and loneliness that resulted from the COVID-19 pandemic.

Twin Pandemics

Some describe this as the collision of twin pandemics. “The pandemic is in many ways a perfect storm for anyone who is struggling with substance use disorder,” Michael Barnett, PhD, assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health, said in a blog post. “People have lost their jobs. Social and family interactions have been limited. And the pandemic itself is depressing and anxiety provoking. These are all stimuli that can stress the psyche and the finances of someone who has an addiction.”

In California, overdose deaths have increased steadily (PDF), according to a March report from the consulting group California Health Policy Strategies. The report compared the increase in overdose deaths from the 2016–17 period to 2019–20. Overdose deaths from psychostimulants, such as methamphetamine, increased 90%, while overdose deaths related to cocaine increased by more than 160%. Opioid overdose fatalities increased 50%, driven in part by a significant spike in deaths from the synthetic opioid fentanyl. Illicit fentanyl is used either as a standalone drug or as a deadly additive to drugs such as heroin, methamphetamine, and cocaine.

While part of the 2019–20 review period in the study preceded the pandemic, a KFF national survey last summer found that 12% of people said they were experiencing increased alcohol or drug use due to worry or stress caused by the pandemic.

Addiction thrives in secrecy, and in the pandemic you have more people alone and not accountable to friends and family.

—Carla Marienfeld, UC San Diego Health

“While everyone’s focus is appropriately on the pandemic, we can’t lose sight of these other huge issues,” emergency physician Robert Rodriguez of Zuckerberg San Francisco General Hospital, told Usha Lee McFarling of Stat. Rodriguez said the emergency department saw many fewer cases of trauma injuries and many more patients suffering from psychological distress and overdose. “Anecdotally, I can tell you drug abuse has definitely risen,” he said.

“Addiction specialists across the country told Stat the overlapping health disasters — the historic COVID-19 pandemic colliding with a preexisting drug epidemic made deadlier by the potent synthetic opioid fentanyl — have been devastating for their patients. Many have simply disappeared; some have died; others have relapsed,” McFarling wrote. Experts cited the isolation that kept people from their social networks and gave them more “privacy to use substances” as a major contributor to increasing overdose deaths, McFarling reported.

“People can’t be around friends, go outside to gyms and restaurants, all of those everyday activities that might mitigate anxiety and depression,” Carla Marienfeld, a psychiatrist who directs the addiction recovery and treatment program at UC San Diego Health, told McFarling. “Addiction thrives in secrecy, and in the pandemic you have more people alone and not accountable to friends and family.”

Worrisome Racial Disparities

Data also suggest that “Black Americans have suffered the heaviest toll” of overdose deaths during the pandemic, reports NPR’s Brian Mann. One study found overdose deaths increased more than 50% among Black residents of Philadelphia in the first three months of the pandemic emergency in 2020, compared to the same period a year earlier. Utsha Khatri, MD, a University of Pennsylvania emergency physician who led the study, told Mann that “COVID really just acted as salt in the wounds of health and social inequities, perpetuated by structural racism both in Philadelphia and across the country.”

“The COVID-19 pandemic has sharply exacerbated the inequities of the overdose crisis, which is really, really scary,” Ayana Jordan, MD, PhD, told Mann. Jordan, a psychiatrist and professor at Yale University’s School of Medicine, is part of a team analyzing overdose data collected in California during the pandemic. She said that the team’s preliminary findings show “really concerning” racial disparities, with overdose deaths rising significantly faster among Black people than among the White population, in which it has remained flat during the pandemic or in some cases dropped.

For all the attention on overdose deaths, it’s worth noting that excessive alcohol use still claims more lives in the US annually than all other drugs combined.

Recent reporting also suggests that women, disproportionately burdened by additional childcare and housework during the pandemic, have increased their alcohol use.

Researchers from the Johns Hopkins Bloomberg School of Public Health and the University of Maryland, Baltimore County, conducted a survey last May that was recently published in the International Journal of Environmental Research and Public Health. More than 800 people responded, mostly White women. Sixty percent reported that they were drinking more than before the COVID-19 emergency, Kim Tingley reported in the New York Times Magazine.

Parents of Online Students Drinking More Now

Factors that were protective before the pandemic, such as being a parent, were no longer keeping people from increased drinking, Tingley wrote. “Parents appear to be among those drinking more now — especially if their children are engaged in remote schooling.”

Elyse Grossman, a policy fellow at Johns Hopkins and lead author of the International Journal article, told Tingley that she expects to start seeing the physical effects of the increased drinking in one to three years, based on what she’s seen after other disasters. Cases of alcoholic liver disease increased an estimated 30% between April 2020 and April 2021 in the University of Michigan health system, and many of those additional patients were young women, Tingley reported.

Excessive alcohol use causes more than 95,000 deaths in the United States each year, according to the CDC. For all the attention on overdose deaths, it’s worth noting that excessive alcohol use still claims more lives in the US annually than all other drugs combined.

Governments Stepping Up

Both the state and federal governments are acting. The Biden administration recently outlined its drug-policy priorities (PDF) — and “expanding access to evidence-based treatment” topped the list. The California Department of Health Care Services is planning to use funds from the federal American Rescue Plan to expand telehealth; provide support for more addiction and mental health clinicians, counselors, and peer support specialists; and in other areas, such as educating school age–children about the risks associated with substance use. The state’s existing Medication-Assisted Treatment Expansion project continues to address the ongoing opioid/fentanyl crisis, and the Drug Medi-Cal Organized Delivery System, already rolled out in most of the state’s counties, has greatly expanded access to evidence-based treatment to people with substance use issues.

Continued funding for treating substance use is crucial for helping people across the country recover from the traumas of the past year. As the Center on Budget and Policy Priorities noted, “Robust and reliable funding for substance use disorder services is essential for closing the treatment gap, where fewer than 13% of the 21 million-plus people who need substance use services get any.”

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Heather Tirado Gilligan

Heather Tirado Gilligan is a journalist who has written for publications including Slate, The Nation, CNN, and the Washington Post. Previously, she was executive editor of the California Health Report, a news nonprofit covering disparities in health and access to health care. Heather received a master’s degree in journalism from UC Berkeley and a PhD in English from Rutgers University, where she studied race in American culture.

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