With hindsight our understanding of the COVID-19 global pandemic caused by the SARS-CoV2 virus, its mutations and related illnesses, has improved (Faust et al., 2021). Sadly, this pandemic coincided with an escalating opioid epidemic that was already reacting to an increased regulation of prescription opioids and turning to a more deadly option, fentanyl and its derivatives. Although difficult to establish causality between these two global “events,” it is clear that there were a greater number of deaths from drug and opioid overdose during the pandemic (Faust et al., 2021Ghose et al., 2022). This link is further explored by Hutchison et al., who found that opioid-induced poisoning and presentation at emergency care increased in line with each phase of the pandemic. Despite this increase, there was a concomitant decrease in the presentation of Opioid Use Disorder (OUD), possibly a result of treatments and diagnoses not being initiated or continued as the medical teams focused on treating COVID-19 patients. Adding to the problem of the lack of available care, the pandemic posed considerable challenges to harm reduction and substance use treatment. This was highlighted by Radfar et al., who showed from a survey of 77 countries, that the supplies of drugs, buprenorphine and methadone, used to treat Substance Use Disorder (SUD) was impacted in almost half of these countries. Also impacting the SUD patients during the pandemic was a psychological vulnerability, manifest as an increase in negative emotions and poor self-concept, or negative affect (NA), in those over 50, in particular females, with SUD, Wang et al. These authors also showed that, in these patients, the degree of NA was positively correlated with the degree of drug use frequency, craving and also impulsivity. This study outlines the vulnerability of older SUD patients during a pandemic that may be associated with social isolation induced by countries around the world to curb the spread of the virus. Fuchs-Leinter et al. added another dimension to the effect of COVID-19 on mental health and surveyed a clinical sample of patients in Opioid Substitution Therapy (OST) for Post-Traumatic Stress Disorder (PTSD) in Austria. Using a scale specifically adapted to assess PTSD symptoms due to the COVID-19 pandemic, these authors found that 27% of OST patients appeared to be at an elevated risk for PTSD with those at highest risk more likely to show increased craving and also greater depression, anxiety and stress. Putting such mental and life stress factors as risk factors into a measurable scale showed a positive correlation with the risk of fatal or non-fatal overdose (Doggui et al.)adding a possible link between the mental health stressors of the pandemic with increased opioid harms of the time.


© 2023 John, Walwyn, DeFea, Hales and Walwyn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. http://creativecommons.org/licenses/by/4.0/

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John, S., Walwyn, D., DeFea, K., Hales, T. & Walwyn, W. 2023, 'Editorial: Opioids in the time of the COVID-19 pandemic: from cellular mechanisms to public health policy', Frontiers in Pharmacology, 14, article no: 1251958. https://doi.org/10.3389/fphar.2023.1251958

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Last updated: 07 August 2023
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