While the onslaught of the COVID-19 pandemic continues, people are being consumed by anxieties and stresses and greatly impacted by economic ravages, which in turn have led to opioid overdoses, excessive consumption of other substances, and problematic behaviors like overuse of the internet and pornography.

To put this into perspective, data from the Recovery Village survey, carried out in late summer/early fall of 2020 asked 1,000 American adults about their substance in the past month and respondents indicated that the most frequently used substances included:

• alcohol (88%)
• marijuana (37%)
• prescription opioids (15%)
• benzodiazepines (11%)
• prescription stimulants (10%)
• cocaine (9%)

Both the frequency (number of days) and amounts of drug and alcohol consumption increased considerably. People in the northeastern states, hardest hit by the pandemic reported a 67% increase in alcohol consumption and 25% significant increase. The three main reasons identified for this increased consumption were dealing with stress, relieving boredom and coping with mental health problems like anxiety and depressive.

The Overdose Detection and Mapping Application Program showed:

• 16% more overdoses in February 2020 than February 2019, escalating to 42% more in May 2020 compared with May 2019
• in Kentucky, overdoses increased by 17% resulting in transportation of the patients to the Emergency Room and in other places across the country
• from March to July 2020, opioid overdose Emergency Room admissions more than doubled from 102 to 227 while other admissions dropped by 29%

When COVID-19 started relentlessly claiming thousands of lives worldwide, and it became imperative to develop and put out a vaccine as soon as possible, but the similar kind of enthusiasm and action has not been seen to counter the problem of deaths occurring due to opioid overdoses during the pandemic, which are largely driven by fentanyl.

The pandemic seems to have firmly put brakes on a lot of the progress that was being made with regard to opioid use disorders. It is also important to remember that those addicted to opioids are a vulnerable and marginalized subset of the population – many are former Veterans with co-occurring post-traumatic stress disorder and other substance use disorders.

On the other hand, more globally, recently published studies focused on how COVID-19 changed patterns of various kinds of addictive behaviors in countries most severely hit by the pandemic. One study in China found that self-reported “severe internet addiction” was 23% higher than in a sample of 340 participants surveyed in October 2019 (Wilcox, 2020).

According to Hans Vestberg, CEO of Verizon Communications Inc., gaming increased by 75% in the US (Clifford, 2020), and according to Sensor Tower, an analytics intelligence platform, the European mobile game download volume reached a record high (increasing by 19%) in March 2020, when strict lockdown measures were implemented (Broughton, 2020).

The switch to online gambling from the traditional form of gambling in casinos has also been particularly disastrous. There is evidence to suggest that online casinos are associated with higher rates of problematic gambling and indebtedness (Håkansson, 2020). Psychoactive substance use has also increased alongside, reinforcing these behaviors as a means to cope with distress.

Additionally, collateral damage has come in the form of increased susceptibility to cybercrime, bullying, scams and scandals that continue to thrive on manipulation and unlawful utilization of sensitive information.

This brings us to three important questions:

1. What is rehabilitation to the pre-pandemic state going to look like, given the extent of damage that has happened as a result of substance use and problematic behaviors?
2. How can we keep the momentum going for endeavors to minimize the burden from escalating substance use, if other priorities claim funding away from these problems in the future?
3. Are we paying enough attention to the societal evils coming both from substance use and excessive internet and porn consumption, should the world choose to continue to function at least on some levels through virtual platforms, thereby cutting opportunities and avenues for much needed social interactions.

I will leave you with that much, as food for thought.

~ Sanya Virani MD, MPH