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Report from the Field: COVID-19 Impact on Overdose Response Activities at Local Health Departments

— Overdose prevention and response activities limited, as local health departments muster all available resources to mitigate pandemic —

Washington, DC, August 3, 2020 – Today, the National Association of County and City Health Officials (NACCHO), representing the country’s nearly 3,000 local health departments, released new data documenting the impact of the COVID-19 response on overdose prevention and response activities at local health departments throughout the country. The work of these local health departments (LHDs) has been severely impacted since the onset of the COVID-19 pandemic, with staff shifted to the pandemic response and challenges to social distancing necessitating changes to traditional public health programming. Despite the ongoing opioid crisis and a new record high for overdose deaths last year, many day-to-day overdose prevention and response activities have been suspended or are operating at a reduced capacity.

NACCHO asked local health departments engaged in specific overdose prevention and response programs and activities about the impact of the pandemic on their work. They noted that while all areas of overdose prevention and response have been limited during this time, activities involving interaction with the public have been most curtailed. These include:

• Suspended or decreased harm reduction and syringe service program activities due to staff reductions and necessary social distancing and sanitation mandates.
• Difficulty connecting to individuals who have experienced overdose. For example, 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. Similarly, 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.
• Challenges to sharing effective forms of provider education, such as academic detailing (a practice where trained educators make in-person visits to health care providers to share best practices and guidelines), which have also been temporarily suspended.
  
• Barriers to accessing Medication Assisted Treatment (MAT), a vital component of effective recovery, which can require daily meetings with a medical provider before medicine can be dispensed. While the federal government has waived many of requirements, allowing for telemedicine and longer-term supplies, LHDS report that these changes are not always being effectively communicated to providers and patients.
• Complications in overdose prevention messaging. For example, messaging and strategies, such as promoting the “buddy system” or discouraging using alone, have been challenged by social distancing recommendations.

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. All of this disruption also takes place within the context of systematic budget and staffing cuts for local public health, who have lost over 20% of their workforce since 2008.

While the full impact of the pandemic on overdoses and the opioid epidemic will not be clear for some time, the COVID-19 pandemic and the reduction in public health services necessitated by the response may have already led to an uptick in overdoses. The Overdose Detection Mapping Application Program, a surveillance system that tracks suspected overdose data nationally in near real-time, has detected an 18% increase in suspected overdoses. 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.

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 to address these issues. These include:

• Transitioning messaging campaigns from billboards and bus-wraps to Instagram and radio ads.
• Shifting operations at syringe service and other harm reduction programs by preparing to-go kits ahead of time to limit the staff needed and the level of client interaction at their physical sites.
• Improving procedures for the peer navigator program intake process that can be implemented when hospitals begin to allow visitors.
• Utilizing video conferencing platforms to facilitate MAT appointments and peer support groups.
• Developing guidance on providing academic e-detailing.
• Deploying 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.
• HIV, STI, and Viral Hepatitis Program
• Vector Control Programs
• Local Health Department Immunization Programs
• Local Food Safety Programs

The full report, including a list of resources to assist overdose prevention and response activities during the COVID-19 pandemic, as well as NACCHO’s Opioid Overdose Epidemic Toolkit, can be found here.

Reports from the Field is a series highlighting the impact of COVID-19 on other public health priorities, including:

For more details on NACCHO’s response to COVID-19, see its COVID-19 information page.