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The Pandemic Stay-at-Home Order and Opioid-Involved Overdose Fatalities

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

In response to the COVID-19 pandemic, Illinois enacted a stay-at-home order on March 21, 2020; the order was lifted on May 30, 2020. This report describes trends in opioid-involved overdose deaths over a 3-year period and highlights the number of deaths during the 11-week Illinois stay-at-home order. Trends in substance involvement are also examined.

Prior to the pandemic, Cook County, Illinois, had already experienced 2 years of high levels of opioid-involved overdose deaths, with a disturbing increase beginning in late 2019 and early 2020.1 Adding to this, people with substance use disorder (SUD), many of whom already experienced trauma and the effects of incarceration, also faced major disruptions in in-person treatment and recovery services during the early stages of the pandemic. For most people with SUD, the pandemic compounded an already tenuous situation with massive losses of service sector jobs and health insurance, and loss of in-person social support, resulting in increased anxiety, depression, and social isolation.2 The pandemic also led to interruptions and changes in the drug supply. Increasing use of illicit fentanyl had already been contributing to an increase in overdose deaths in Cook County.3 Fatal overdose risk is amplified when powerful, illicitly manufactured opioids are substituted for less potent drugs, which may have been unavailable during lockdown.

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Article Information

Corresponding Author: Maryann Mason, PhD, Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Ninth Floor, Chicago, IL 60611 (maryann-mason@northwestern.edu).

Published Online: April 23, 2021. doi:10.1001/jama.2021.6700

Conflict of Interest Disclosures: None reported.

References
1.
Opioid data dashboard. Illinois Department of Public Health. Published 2020. Accessed April 19, 2021. http://idph.illinois.gov/opioiddatadashboard/
2.
Englander  H , Salisbury-Afshar  E , Gregg  J ,  et al.  Converging crises: caring for hospitalized adults with substance use disorder in the time of COVID-19.   J Hosp Med. 2020;15(10):628-630. PubMedGoogle ScholarCrossref
3.
Feinglass  J , Walker  G , Khazanchi  R ,  et al.  Community versus hospital opioid-related overdose deaths in Illinois.   Public Health Rep. 2021;33354921994901. doi:10.1177/0033354921994901PubMedGoogle Scholar
4.
Mason  M , Welch  SB , Arunkumar  P ,  et al.  Opioid overdose deaths before, during, and after an 11-week COVID-19 stay-at-home order—Cook County, Illinois, January 1, 2018-October 6, 2020.   MMWR Morb Mortal Wkly Rep. 2021;70(10):362-363. PubMedGoogle ScholarCrossref
5.
Cook County Government. Medical examiner case archive. Published 2020. Accessed March 22, 2021. https://datacatalog.cookcountyil.gov/Public-Safety/Medical-Examiner-Case-Archive/cjeq-bs86/data
6.
CDC. Increase in fatal drug overdoses across the United States driven by synthetic opioids before and during the COVID-19 pandemic. December 17, 2020. Accessed March 22, 2021. https://emergency.cdc.gov/han/2020/han00438.asp
7.
Larochelle  MR , Bernstein  R , Bernson  D ,  et al.  Touchpoints—opportunities to predict and prevent opioid overdose.   Drug Alcohol Depend. 2019;204:107537. doi:10.1016/j.drugalcdep.2019.06.039PubMedGoogle Scholar
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Potier  C , Laprévote  V , Dubois-Arber  F ,  et al.  Supervised injection services: what has been demonstrated?   Drug Alcohol Depend. 2014;145:48-68. doi:10.1016/j.drugalcdep.2014.10.012PubMedGoogle ScholarCrossref
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Alegría  M , Frank  RG , Hansen  HB ,  et al.  Transforming mental health and addiction services.   Health Aff (Millwood). 2021;40(2):226-234. PubMedGoogle ScholarCrossref
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