While 2020 has been a difficult year overall, it has also been a particularly bad year for opioid overdoses in North Carolina. The increase in substance abuse and overdoses stems from the social isolation brought on by lockdowns. Not being able to see family and friends for long periods damages physical and mental health, meaning that people turn to substance use to pass the time. The pandemic has also provoked worse mental health symptoms: whether an increase in stress, anxiety or depression, the pandemic has made it hard for people to maintain a positive mental state.
The 2020 pandemic has also spurred job loss and financial issues. By April of 2020, 20.6 million jobs were lost in the United States, putting the unemployment rate at 14.7%, which had not been that high since the Great Depression.1 Job instability and financial hardships have worsened mental health symptoms and brought about increased substance use. Working from home has also made it easier for people to use substances throughout the day as they are not in the office.
The Centers for Disease Control and Prevention reported that more than 81,000 people across the U.S. died from drug overdoses between June 2019 and May 2020, the highest number of deaths ever recorded in twelve months.2 The jurisdictions with the largest increase in overdose deaths between July 2019 and July 2020 included Louisiana with a 53.1% increase, South Carolina with a 43.6% increase, the District of Colombia with a 59.9% increase, Maine with a 40.6% increase, and Arizona with a 35.9% increase.3
The increase in substance abuse in the U.S. and North Carolina has resulted in a rise in overdoses. Studies showed an increase of about 23% of overdose-related emergency room visits from 2019 to 2020.2 In the past year, the number of people in Wake County who survived an overdose and were referred to substance abuse treatment jumped to 30%.3 With more people in isolation and less around to provide support and help in the event of an overdose, substance users are more often ending up in the hospital.3
The pandemic has also made substance use disorder treatment more difficult to access. With the country shutting down and restrictions on gatherings, substance use treatment has become more difficult to access. Rather than in-person counseling or treatment, a lot of support groups are being held over Zoom which can pose a barrier to participation. Additionally, funding previously intended for treatment programs has been re-allocated to fight the COVID-19 pandemic, decreasing the resources available for individuals to seek treatment.4
According to the North Carolina Department of Health and Human Services, in December 2019, North Carolina had 579 overdose emergency-room visits. Compared to the 658 cases in December 2020, there was an increase of 13.5%. From 2016 to 2020, there was an increase of 23% in overdose emergency-room visits in North Carolina. The counties with the highest number of overdose-related emergency-room visits were Burke, Randolph, Carteret, Craven, and Catawba. In the last twelve months, the North Carolina Alcohol and Drug Council reported that almost 9,200 people were referred to substance abuse disorder treatment.5
Cumberland has had a higher overdose death rate, opioid pill-per resident rate, more opioid-related hospitalization, and more total overdoses than the rest of North Carolina. Cumberland county has many individuals who are on long-term opioid treatments. Using opioids for long periods significantly increases the risk of abuse and addiction. Heroin is also easier and cheaper to obtain in Cumberland county. Heroin and other substances are being laced with fentanyl, which has spurred an increase in overdoses. The initiatives taken between 2019 and 2020 to lower the opioid overdoses were undone by Covid-19. Health officials had to turn their focus towards the pandemic, leaving behind individuals struggling with opioid addiction.6
Fayetteville is another North Carolina county that has experienced high rates of opioid abuse. A 2016 report found that Fayetteville had the 18th highest opioid abuse rate in the U.S. Fayetteville also has 750 patients doing medication-assisted therapy. One Fayetteville resident reported that she had six friends die from drug overdoses in the last year. Another resident described being treated poorly when trying to receive treatment.7
In early February 2021, the North Carolina Attorney General announced that a McKinsey consulting firm was to pay out a $573 million settlement to forty-seven states for their part in helping businesses to increase their sales of opioid painkillers. Of this settlement, North Carolina will receive $19 million that will be used to battle the opioid crisis.8
In 2018, North Carolina saw rates of opioid overdoses drop for the first time in five years. Unfortunately, Covid-19 has reversed that progress. Increased depression and anxiety during the pandemic have led to an increase in prescription medication abuse. In North Carolina, suicides have increased 1000%, mental health calls have increased 850%, alcohol sales are up 250-300%, prescriptions for anti-anxiety medications, and Xanax and sleeping pills are up 63%.8 There is hope that the $19 million paid out over five years will help to combat these growing issues.
On top of the growing issue of opioid overdoses and increases in substance abuse, rehabilitation and treatment facilities have also taken a hit due to the pandemic as they are unable to keep up with the growing demand for treatment. More than half of the rehabilitation facilities in North Carolina closed at least one program, and many facilities have laid off staff. A recent survey by the Addiction Professionals of North Carolina found that 43% of treatment facilities will not be able to survive another month.
With many services becoming virtual, individuals cannot receive the needed in-person treatment and support.8 This provides an additional barrier to the homeless population or individuals who don’t have access to the internet or computers. A huge component of treatment is leaving the house and visiting a treatment center to meet people going through the same struggle. Sitting at home and receiving treatment virtually may not have the same benefits.