Conceptualizing the effects of the COVID-19 pandemic on people with opioid use disorder: an application of the social ecological model

Abstract

The COVID-19 pandemic has resulted in unparalleled societal disruption with wide ranging effects on individual liberties, the economy, and physical and mental health. While no social strata or population has been spared, the pandemic has posed unique and poorly characterized challenges for individuals with opioid use disorder (OUD). Given the pandemic’s broad effects, it is helpful to organize the risks posed to specific populations using theoretical models. These models can guide scientific inquiry, interventions, and public policy. Models also provide a visual image of the interplay of individual-, network-, community-, structural-, and pandemic-level factors that can lead to increased risks of infection and associated morbidity and mortality for individuals and populations. Such models are not unidirectional, in that actions of individuals, networks, communities and structural changes can also affect overall disease incidence and prevalence. In this commentary, we describe how the social ecological model (SEM) may be applied to describe the theoretical effects of the COVID-19 pandemic on individuals with opioid use disorder (OUD). This model can provide a necessary framework to systematically guide time-sensitive research and implementation of individual-, community-, and policy-level interventions to mitigate the impact of the COVID-19 pandemic on individuals with OUD.

Response to Routsolias and Mycyk Letter

“…12,13 First, evidence suggests that people with OUD may be at higher risk for experiencing COVID-19 infection due to a higher prevalence of pre-existing conditions, smoking, opioidrelated immunosuppression, and the presence of structural lung disease. [14][15][16][17] In addition, those with OUD are more likely to reside in congregate living situations such as group recovery housing, shelters, and correctional facilities where they may be unable to maintain social distancing. 14,15 People with OUD also make up a disproportionate share of the United States unsheltered and unstably housed population, placing them at further risk for exposure to COVID-19.…”

“…14,15 People with OUD also make up a disproportionate share of the United States unsheltered and unstably housed population, placing them at further risk for exposure to COVID-19. 16,18 Although social distancing is an important public health measure, there is potential for the isolation associated with COVID-19 to cause harm for those with OUD. 19 There is a strong association between social isolation, mood, and substance use disorders.…”

“…This lessens the potential for administration of bystander naloxone, contributing to overdose deaths. 16 There is also evidence that pandemic-related disruptions to existing drug trafficking patterns and supply chains increase risk for those with OUD. 16,19,21 Faced with a lack of usual supply, people who use drugs are forced to seek substances from places other than their known and trusted sources, increasing the risk of exposure to adulterated or contaminated substances.…”

“…16 There is also evidence that pandemic-related disruptions to existing drug trafficking patterns and supply chains increase risk for those with OUD. 16,19,21 Faced with a lack of usual supply, people who use drugs are forced to seek substances from places other than their known and trusted sources, increasing the risk of exposure to adulterated or contaminated substances. 16,19 Recent research conducted by Niles et al 22 documented a 50% increase in the risk of urine positivity for nonprescribed fentaNYL during the pandemic, despite a substantial decrease in urine drug testing overall.…”

“…16,19,21 Faced with a lack of usual supply, people who use drugs are forced to seek substances from places other than their known and trusted sources, increasing the risk of exposure to adulterated or contaminated substances. 16,19 Recent research conducted by Niles et al 22 documented a 50% increase in the risk of urine positivity for nonprescribed fentaNYL during the pandemic, despite a substantial decrease in urine drug testing overall. They also observed significant increases in positivity for high-risk drugs (heroin, fentaNYL, opioids, benzodiazepines) and dangerous drug combinations (eg, fentaNYL and opioids).…”