“Overdose prevention and response activities have not been spared, as local health departments muster all available resources to mitigate the toll of the virus.”
The work of local health departments (LHDs) has been severely impacted since the onset of the COVID-19 pandemic. Much of their staff has been activated as part of an emergency response to combat the virus, and many of their day-to-day activities have been suspended or are operating at a reduced capacity. Overdose prevention and response activities have not been spared as LHDs muster all available resources to mitigate the toll of the virus.
While all areas of opioid prevention and response have been limited during this time, activities involving interaction with the public have necessarily been most curtailed. Harm reduction and syringe service programs that provide live saving supplies to people who use drugs have had to suspend or decrease their activities, both due to staff reductions and onerous, though necessary, social distancing and sanitation mandates. Peer recovery specialists have found themselves unable to visit individuals immediately post overdose as hospitals have limited visitors to mitigate risk of COVID-19 spread to their patients and staff. Likewise, effective forms of provider education, such as academic detailing (a practice where trained educators make in-person visits to health care providers), have also been temporarily suspended. Support groups for individuals in active or contemplative recovery have had to move online, disrupting what for many is both an essential part of their routine and a source of comfort, camaraderie, and motivation. Data collection efforts that require community input have been postponed or conducted digitally. Medication Assisted Treatment (MAT), a vital component of effective recovery, requires in some cases daily meetings with a medical provider before medicine can be dispensed. While HHS has waived many of the most onerous requirements, allowing for telemedicine and longer-term supplies, these changes are not always being effectively communicated to providers and patients.
Even overdose prevention and response activities that lack an in-person element have been impacted. Epidemiologists and communication specialists, for example, have in many cases been reassigned to focus on the response to the virus. Even proven messaging and strategies, such as promoting the “buddy system” or discouraging using alone, which don’t necessarily involve further staff time, have been confounded by social distancing recommendations. All of this disruption also takes place within the context of systematic budget cuts for local public health, whose funding has dropped by almost 20% since 2010.[i]
Unfortunately, the pandemic and the reduction in public health services necessitated by the response may have led to an uptick in overdoses. The Overdose Detection Mapping Application Program (ODMAP), a surveillance system that tracks suspected overdose data nationally in near real-time, has detected an 18% increase in suspected overdoses. Additionally, 61% of participating counties have reported overdoses, with many noticing a pattern whereby more overdoses occurred in suburban and outlying areas than would normally have been predicted.[ii] This tracks with what NACCHO has heard from current partner LHDs working on overdose prevention and response, some of whom have reported as much as a 62% increase in drug overdose fatalities. It would be too speculative to pin down this increase on any particular set of variables, but certainly the virus has increased the likelihood of risk factors in the lives of many. A reduction in available public health services aimed at people who use drugs may unfortunately be one part of the equation.
Despite all this, LHDs have found a number of ways to innovate and continue offering services to people who use drugs. In some cases, they have even rolled out new services that benefit this population. Messaging campaigns have transitioned from billboards and bus-wraps to Instagram and radio ads. Syringe service and other harm reduction programs have begun preparing to-go kits ahead of time to limit the staff needed and the level of client interaction at their physical sites. Peer navigators have continued to work with their established clients and taken the time to put into place improvements to the intake process that can be implemented when hospitals begin to allow visitors. MAT providers and peer support groups, like many of us, have begun learning to use Zoom and Skype to conduct their sessions. Academic detailing experts have released guidance on conducting e-detailing. Data collection efforts have likewise moved over to digital platforms. Finally, many LHDs have helped stand up hygiene stations, which offer services like mobile bathrooms, sinks, and even showers, in locations such as churches and public parks. While this is more directly targeted at the unhoused population, there is significant crossover with people who use drugs.
NACCHO has compiled a list of resources from national partners that may prove helpful for LHDs.
More resources on overdose prevention and response can be found by searching the Opioid Overdose Epidemic Toolkit. The toolkit is a free, online collection of public health tools that have been created and shared by members of the public health community.
Except where sources are specifically cited, information in this blog post is drawn from conversations with LHDs currently engaged in projects with NACCHO as well as subject-matter workgroups and communities of practice.
If you have any questions about these resources or would like to submit a tool of your own to the Opioid Overdose Epidemic Toolkit, please contact the NACCHO Injury and Violence Prevention team at firstname.lastname@example.org.
For more details on NACCHO’s response to COVID-19, see its COVID-19 information page. If you would like to share how the COVID-19 response is affecting your local overdose prevention and response program, please submit your stories on this short form. This feedback is critical to our work to advocate on your behalf. Thank you.