The pandemic is exacerbating other, co-occurring epidemic(s)

Editor’s Note: Today’s post comes from guest writers Mae Tidd and Deepika Rao, graduate students at UW-Madison in the Health Services Research in Pharmacy Program. 

Mae’s research interests focus on LGBTQ+ health and health communication in pharmacy spaces and wider medical spheres. She studies the promotion of health information (between physician and patient, health education, and public health campaigns), health activism, and community/stakeholder engagement. More specifically, she is working to understand HIV-prevention’s pre-exposure prophylaxis (PrEP) uptake, or the lack thereof, in the state of Wisconsin by identifying barriers that are obstructing health services along the cascade of the PrEP Continuum of Care. 

Deepika is particularly interested in studying the use of dissemination and implementation sciences in pharmacy, especially in the prevention and treatment of substance use disorders. Currently, her primary research involves using mixed methods approaches to explore and develop patient-centered interventions for opioid misuse that can be implemented in the pharmacy settings. 

The current pandemic continues to be the front of discussion, as it should be. Yet, we need not to forget the other epidemic(s) that continue to occur: opioid overdoses, HIV, and the effects of systemic racism chief among them. This is especially true because people among the subgroups affected by these epidemics are at increased risk for the coronavirus and face significantly more problems accessing health care.

As we head into the fifth month of seized day-to-day life, the repercussions of COVID-19 are more than apparent – numerous people are (still) unemployed, mentally drained, isolated, and even homeless. The high number of COVID deaths are compounded by the fact that there are also numerous long-term COVID patients who are still suffering from incapacitating symptoms. With no end in sight, society is flooded with uncertainty.

These repercussions are concerning as they impact the mass majority. Yet at a heightened concern is the pandemic has exacerbated issues for the 20 million+ people in the US battling a substance use disorder.

With the lack of health care services for people with substance use disorders and most health care prioritizing COVID-19, access to treatment and harm reduction services has severely decreased. Increase in homelessness due to the pandemic has meant higher risk of contracting COVID and increased chances of risky behaviors such as sharing needles. Also, increased loneliness, stress, and financial burdens among unpaid caregivers of COVID patients, essential workers, and racial/ethnic minorities have elevated mental health issues. These conditions cause poor mental health outcomes, increased substance misuse, and higher suicidal ideation.

Experts state that along with the spike in coronavirus cases, there have been a rise in relapse and overdoses. In fact, The New York Times referred to the COVID-19 pandemic as a “national relapse trigger”.

National efforts had made great progress in stemming the opioid crisis, but since the pandemic hit numbers indicate some worrisome trends. Alcohol sales are up 27%, and urine analysis’ by Millennium Health have indicated a 32% increase for nonprescribed fentanyl, 20% for methamphetamine, 10% for cocaine, and 13% for heroin. And consequently, the rise in drug misuse has increased suspected overdoses nationally from 18% at the beginning of the stay-at-home order to 42% in May – with an overall 11% increase in drug overdose deaths. With most substance use disorder treatment being critically dependent on face-to-face interaction, most patients are left with no options.

As if overdoses ending at the morgue are not enough to be concerned about, the increased chances of risky behavior could lead to another life-threatening diagnosis – HIV.

Roughly, 10% of newly diagnosed HIV cases are among people who inject drugs (PWID). Simultaneously, there have been increased efforts to combat the opioid and HIV epidemics with syringe service programs. These programs are centered on health care professionals offering patients sterile syringes or needles without a prescription, sometimes in exchange of used unclean ones. The lack of strong support for such programs even before the pandemic has further worsened with current COVID restrictions. With these additional obstacles of obtaining sterile syringes and an increase in intravenous drug use, there is potential for an increase in HIV cases among PWID.

Mayhem, aside from the coronavirus, still occurs.

In the past five months the talk of the opioid crisis has been minimal to sheer none. In fact, Dr. John Kelley from Massachusetts General Hospital’s Recovery Research Institute states: “The opioid crisis hasn’t just gone away. It’s not solved. It’s [just] been shoved into the background by the 24/7 COVID-19 news cycle”.

Yet, this week at the Republican National Convention, speakers were quick to honor President Trump on his “turning of the tide” on the opioid epidemic. While the Trump Administration takes credit for the nationwide reduction of opioid prescriptions, even though the notable progress actually began under the Obama administration, fatal opioid-related overdoses are up 10% since 2016.

And as we head into presidential debates and the election these next few months, the talk of these co-occurring epidemics are guaranteed to be hot topics.

The coronavirus pandemic is not over, and an end is nowhere in sight. The opioid epidemic has not been combated. The HIV epidemic is still occurring. Unfortunately, we can only move forward, therefore how exactly will President Trump and Democratic nominee Joe Biden address these crises? What plans are at hand for the war on drugs? Police reform and systemic racism? The HIV Epidemic?

Beyond battling COVID-19, there is a world of other problems waiting for the next president now and when he takes office in January 2021. And none of them can wait much longer.

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