Opioid Substance Use Issues Associated with the COVID-19 Pandemic

Nicotine use—via both combustible cigarettes and e-cigarettes—is associated with worse COVID-19 outcomes. A meta-analysis found that a history of smoking is associated with greater COVID-19 disease progression, and a cross-sectional survey of U.S. adolescents found that e-cigarette and cigarette use is associated with a higher risk of testing positive for COVID-19.

Nicotine Substance Use Issues Associated with the COVID-19 Pandemic

During the COVID-19 pandemic, there were significant concerns regarding elevated alcohol consumption among the general public. Driven by increased psychological distress and social isolation, this rise in alcohol use carried severe risks, including acute consequences like alcohol poisoning and long-term issues such as the development or exacerbation of Alcohol Use Disorder (AUD).

Alcohol Use Issues Associated with the COVID-19 Pandemic

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Due to the extensive life and routine changes caused by the COVID-19 pandemic, substance use issues have emerged as increasingly relevant public health problems that need to be addressed.

Substance Use Issues Associated with the COVID-19 Pandemic

- Being at heightened risk of contracting the disease (elderly, people with compromised immune function, people living in congregate settings)
- Burnout and strain against healthcare workers
- Contracting COVID-19
- Having preexisting medical, psychiatric or substance use condition
- High-risk groups (women, students)
- Job loss and income insecurity
- Poor health
- Social isolation

Mental Health Risk Factors

- Immediate impacts on treating SUDs
- Treatment of SUDs post-pandemic (short-term)
- Treatment of SUDs post-pandemic (long-term)

COVID-19's Impact on SUDs

5.2 million people filed for unemployment benefits during the week of April 5, bringing the four-week total to a historic 22 million people filing for unemployment.  Additionally, as unemployment rises and a recession nears, suicides may increase. During the Great Recession, the U.S. unemployment rate rose to 10% and was associated with increases in suicide rates.

Risk due to job loss and income insecurity

Burnout is particularly high among young registered nurses or nurses with low nurse to patient ratio.  Physicians also tend to have a high burnout which leads to mental health disorders and substance abuse.  Risk of suicide is also high among physicians.

Burnout and strain against healthcare workers

According to the CDC, people who have chronic illnesses such as chronic lung disease, asthma, serious heart conditions, and diabetes are among those with a high risk of severe illness from COVID-19.  mental health disorders are common comorbidities among patients with these and other chronic illnesses. 

Risk associated with poor health

Elderly, due to their heightened risk of contracting COVID-19 from their weakened immune systems, are also at higher risk for increased anxiety, stress and fear. 

Psychological attention should be directed on:
- Female seniors
- Low-educated seniors
- Divorced and widowed seniors
- Those living alone
- Those with sleep issues
- Those with mental health issues

Higher risk groups for mental health issues within.the elderly population

Former U.S. Surgeon General Vivek Murthy has brought attention to the widespread experience of loneliness as a public health concern in itself, pointing to its association with reduced lifespan and greater risk of both mental and physical illnesses (Dr. Murthy serves on the KFF Board of Trustees). Social isolation also serves as a potential stressor.


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