The far-reaching effects of the coronavirus pandemic continues to present challenges to primary care and mental health providers. Depression and anxiety have been predictably impacted by isolation and perceived health risks that our patients are experiencing. It has become more evident as time has passed, that people struggling with substance abuse are at higher risk than ever. A recent brief from the American Medical Association (AMA 2020) tabulates evidence that rates of death due to opioid overdose, already increasing prior to the pandemic, have accelerated—this has been noted in San Diego with increased overdoses with fentanyl have been documented. Stimulant abuse has increased, and the rates of alcohol consumption appears to be on the rise.
Leaders in the field have highlighted this situation as a “perfect storm” of risk factors facing individuals already dealing with substance abuse (Spagnolo et al, 2020) as well as for individuals with risk and vulnerability in the face of the ongoing stressors. First, the authors note that the use of substances increases the medical consequences associated with Covid infection. Second, the stress associated with social isolation and the related economic and interpersonal hardships experienced by many increases their vulnerability to substance use behaviors – both with new onset of drug use and with increased amounts of use. Finally, the virus has limited access to essential treatment for many.
Given these factors, it is more important the ever to screen our patients for substance use. This can be achieved either through direct inquiry (“We’ve noted an increase in individuals experiencing problems with alcohol, marijuana and other substances, so I am asking all my patients to see if they are having difficulties.”) or through use of screening tools to identify problems For adolescents the CRAFFT Screening Test is useful (CRAFFT stands for the key words of the 6 items in the second section of the assessment – Car, Relax, Alone, Forget, Friends, Trouble). For adults and older adolescents the AUDIT (The Alcohol Use Disorders Identification Test) or the ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) can be utilized.
ASSIST: https://www.who.int/management-of-substance-use/assist/
AUDIT: https://www.drugabuse.gov/sites/default/files/audit.pdf
CRAFFT https://crafft.org/
Encouraging those who are at risk or those who meet criteria for substance abuse disorders to participate in substance abuse treatment can be a helpful intervention. While treatment resources in our communities may be limited, patients can be referred to SmartCare for assistance in further identifying their needs and potential services.
Additional resources include:
National Institute on Alcohol Abuse and Alcoholism: Treatment locators, and information for patients and providers
Substance Abuse and Mental Health Services Administration: Treatment locators and extensive links to research
https://www.samhsa.gov/find-treatment
References:
American Medical Association. (2020). Issue brief: Reports of Increases in opioid-related overdose during COVID pandemic. Advocacy Resource Center, (312), 1–5. Retrieved from https://www.fresnosheriff.org/media-relations/beware-of-potentially-fatal-fentanyl-pills-%0Ahttps://chicago.suntimes.com/2020/5/13/21257820/dupage-opioid-overdose-death-
Spagnolo, P., Montemitro, C., & Leggio, L. (2020). New Challenges in Addiction Medicine: COVID-19 Infection in Patients With Alcohol and Substance Use Disorders—The Perfect Storm. American Journal of Psychiatry, appi.ajp.2020.2. https://doi.org/10.1176/appi.ajp.2020.20040417