Introduction
The "World Drug Report 2019" indicates that 271 million individuals worldwide aged 15 to 64 used an illegal drug in the past year, with 35 million experiencing substance use disorders. These substances include alcohol, cannabis, opioids, stimulants, and nicotine. In the Eastern Mediterranean Region, cannabis is the most commonly used drug, while opioids and stimulants are the primary reasons for seeking health services. Reports indicate a rise in the misuse of prescription drugs, such as opioid analgesics (for example, Tramadol) and benzodiazepines, in some population groups within the region. The COVID-19 pandemic has caused significant fear and anxiety. Concerns about severe illness or death from the infection, as well as measures like isolation, quarantines, lockdowns, and physical distancing, contribute to this stress. Using substances to prevent or treat COVID-19 is strongly discouraged, as they offer no protection against the virus.
What Is the Relationship Between the Pandemic and Drug Use?
It is important not to attribute all increases in drug use directly to COVID-19. Changes in drug availability may also play a role; for instance, if heroin is difficult to obtain, individuals might turn to stronger substances like fentanyl. However, experts agree that pandemic-related stresses, such as economic strain, loneliness, and anxiety about the virus, are significant factors driving the increase in drug use. Elevated stress and isolation lead to unhealthy decisions, including increased consumption of alcohol and drugs.
As stress levels rise, fewer opportunities for stress management contribute to the uptick in substance misuse. Activities that promote resilience, such as physical exercise and social interactions, have been less accessible or safe, leading some to turn to drug use more frequently or in larger amounts.
Practical reasons related to the pandemic also contribute to the rise in overdoses. Increased drug use in isolation raises the risk of fatal overdoses, as there is no one to call for emergency assistance or administer Naloxone, an opioid-reversal agent. The pandemic has made it harder for individuals to access medical care for opioid recovery, as some clinics and community organizations have reduced their services.
In March and April, Methadone clinics in Kentucky observed a rise in patients discontinuing treatment and a decline in new patients starting treatment. Physicians have been primarily focused on COVID-19, overwhelming medical systems and limiting access to necessary care. Additionally, the stigma surrounding substance use disorder further discourages individuals from seeking treatment, exacerbated by the pandemic.
How Has Telemedicine Improved Access to Healthcare?
Access to care for substance use disorders has improved during the pandemic due to the increased availability of telemedicine for behavioral health concerns. Initially, many clinics and community-based organizations closed, but physical and mental health telehealth options have since expanded as insurance providers and organizations recognized the need. Additionally, virtual meetings for community-based groups like Narcotics Anonymous and Alcoholics Anonymous have become more common. Most insurers, including Medicaid, have lifted previous telehealth restrictions on treatment for behavioral health, including substance use disorders.
For instance, patients can now begin buprenorphine treatment for opioid recovery through telehealth without an in-person exam. Opioid Treatment Program providers at Methadone clinics have also increased the frequency of take-home Methadone for maintenance. Normally, patients need to be highly stable to take home up to 30 doses, but requirements have been relaxed so that daily visits to opioid treatment programs are not necessary.
Improved access to telehealth allows individuals with substance use issues to seek remote mental health care. Although access can be challenging for those without reliable internet or phone service, clinicians report that more patients are attending psychotherapy appointments thanks to telehealth. Changes in treatment infrastructure during the pandemic have made telehealth more available, helping some individuals on the verge of seeking help to pursue it.
How Psychologists Can Help?
Psychologists are well-equipped to support patients with substance use disorders, and their approach varies based on the type of drug involved. For opioid use disorder, medications like Buprenorphine are essential for treatment. Encouraging patients to seek medical treatment is crucial in preventing long-term impacts, including overdose. Concurrent psychological treatment helps patients adhere to their medication schedule, manage stressors that contribute to opioid use, and address related conditions such as pain, post-traumatic stress, anxiety, and depression.
Advocacy for expanded availability of Naloxone is also important, as it can be obtained from pharmacies in certain states for emergency treatment of narcotic overdoses. Increasing awareness of Naloxone's life-saving potential is critical.
For stimulant use disorders, such as those involving cocaine and methamphetamine, there are no FDA-approved medications, but behavior-based interventions like cognitive behavioral therapy (CBT) are effective. Combining CBT with contingency management, which provides rewards for drug-free behavior, is another helpful approach.
Regularly inquiring about substance use with all patients is recommended, regardless of a formal SUD diagnosis. Given the increased likelihood of substance misuse due to ongoing stressors and limited coping options, it is important not to make assumptions.
When patients disclose substance use, extending compassion and helping them understand how stressors influence their behavior is key. Conducting a functional analysis of the substance's role in their lives can be more beneficial than assuming they want to quit.
Recognizing that weekly outpatient appointments may not suffice for every patient, especially during the pandemic, is essential. Coordinating care with other providers and adding structure and support to patients' routines are crucial steps. Intensive outpatient programs and virtual community support groups can be valuable resources. Tailoring treatment to each patient's unique needs is fundamental in supporting those struggling with substance use.
What Are the Implications for Prevention?
Preventive measures need to adapt to the changing patterns of substance use. This means focusing on vulnerable populations and adjusting to the new realities after the pandemic.
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Prevention Strategies: Enhancing community outreach and education efforts is crucial. This involves using digital platforms to share information about the dangers of substance use and available support services.
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School-Based Programs: With many schools operating online, prevention programs in schools must also go digital. It is essential that students continue to learn about the risks of substance use and have access to mental health resources.
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Policy and Regulation: Policymakers should implement regulations to control increased substance access. This includes stricter oversight of online sales and delivery services for alcohol and prescription drugs.
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Economic Support: Comprehensive economic support, including unemployment benefits, housing assistance, and other financial aid programs, is needed to address the underlying causes of increased substance use, such as financial stress.
Conclusion
The COVID-19 pandemic has significantly impacted substance use patterns and exacerbated related health issues due to increased stress, isolation, and limited access to coping mechanisms. The rise in drug use and overdoses highlights the need for enhanced support systems, including expanded telehealth services and greater accessibility to treatment options like Naloxone. Psychologists play a crucial role in addressing substance use disorders through tailored interventions, combining medical and behavioral treatments. Preventive strategies must adapt to the evolving landscape, focusing on vulnerable populations, digital outreach, and comprehensive economic support to mitigate the underlying causes of substance misuse.
