Fatal opioid overdoses in Cook County spiked in first COVID stay-at-home order

• Link to: Northwestern Now Story

The number of fatal opioid overdoses in Cook County spiked during Illinois’ first 11-week COVID-19 stay-at-home order last spring, a new Northwestern Medicine study has found. 

“People could be staying at home and using alone, which limits the possibility that a bystander can call 911 or give naloxone to reverse the overdose,” said corresponding author Maryann Mason, associate professor of emergency medicine at Northwestern University Feinberg School of Medicine. “There has been a disruption in the drug market associated with COVID, so if people aren’t able to get their usual supply from their usual supplier, they have to go to new people and possibly take new substances that are too powerful for them.”

The study will be published in the March 12 issue of the journal Morbidity and Mortality Weekly Report. 

Average weekly deaths rose 23.7% during stay-at-home order

Intended to curb the spread of the virus, Illinois enacted its stay-at-home order March 21, 2020 and lifted it May 30, 2020. The study found:

• In the 16 weeks leading up to the stay-at-home period (beginning in late 2019), the average number of weekly fatal opioid overdoses increased from 22.6 to 35.06
• During the 11-week stay-at-home period, the average number of weekly overdose deaths increased from 35.06 to 43.4
• In the 18 weeks after the stay-at-home order was lifted, the average weekly deaths sharply declined to 31.2

Despite the sharp decline in fatal opioid overdoses after the stay-at-home order lifted, Cook County’s opioid overdose deaths in general continue to be on the rise since late 2019, the study found. 

“This is concerning because it might indicate an overall persistent upward trend in overdose deaths,” Mason said. 

New insight on risks for opioid users during pandemic

The findings help better understand how people who are vulnerable may be impacted in a health crisis such as a pandemic, Mason said. 

“Almost no one is unaffected by the opioid crisis,” Mason said. “This awareness helps us understand the relatively greater risks of the pandemic for people who use opioids, and it calls attention to the need to support people with opioid misuse during these times and the ‘collateral’ damage of a pandemic beyond COVID deaths.” 

While it’s difficult to pinpoint the exact reason for the increase in deaths, the study authors said a number of factors could be at play:

• During the pandemic, treatment, recovery services and social support for people addicted to opioids has been disrupted.
• The pandemic has led to interruptions and changes in the drug supply. This can result in loss of drug tolerance and the substitution of more powerful, illicitly manufactured opioids, such as fentanyl, for less potent drugs that are unavailable during lockdowns.
• During the stay-at-home order, people may have used opioids alone at home where there we no bystanders available to administer naloxone, a medication that can reverse opioid overdose effects when given in time.

Improving the safety of the drug supply

Using nationwide data, the U.S. Centers for Disease Control (CDC) has reported increased proportions of deaths involving illegally made fentanyl, a synthetic drug that gives users a euphoric high similar to heroin but 10 times stronger. 

“There’s now a demand for fentanyl because people like the high it gives them, and so they seek it out,” Mason said. “It’s something you can develop a tolerance to." 

But for someone who has never before used fentanyl, even a very small amount – equal to that of a grain of sand – could kill them if it is unknowingly mixed with another drug, Mason said. 

“How do we talk about safe drug use with people who are in the market for very dangerous drugs?” Mason said. “Where do we go from here in this 20-year crisis?”

The State of Illinois has current opioid crisis response grants in place, which help fund efforts to provide more overdose prevention strategies for opioid users, Mason said. Also, groups like The Chicago Recovery Alliance (CRA), a non-profit organization that provides syringe exchange and overdose prevention services to Chicagoans, provides real-time drug checking using spectrometer machines and fentanyl test strips. These help identify if heroin, pills, methamphetamine, cocaine, MDMA or other drugs have been adulterated with fentanyl. Combined with substance use management counseling, drug checking can prevent overdoses. 

“We all know people who have this problem that we never would have guessed,” Mason said. “To some extent, we have to do what we can to improve the safety of the drug supply.” 

How the study worked

The study analyzed data from Cook County medical examiner’s office to look at overdoses before, during and after the stay-at-home order in Cook County. The number of weekly deaths were calculated for the weeks between January 1, 2018 and October 6, 2020. A total of 3,843 opioid overdose fatalities occurred in Cook County in that time, with the weekly count of deaths ranging from 12 to 52.

Other Northwestern co-authors include Joseph Feinglass, Lori Ann Post, Sarah Welch and Dr. Ponni Arunkumar.