COVID-19 Pandemic Mitigation, Community Economic and Social Vulnerability, and Opioid Use Disorder

Opioid use disorder (OUD) is a serious national crisis that affects public health and economic welfare, even prior to the COVID-19 pandemic. The COVID-19 pandemic and the mitigation policies to prevent the spread of SARS-CoV-2 upended social networks, healthcare access, led to historically high unemployment, and amplified pre-existing community and economic vulnerability. Communities of color were hardest hit and highlight pre-pandemic disparities in health, mortality, and well-being, including structural community contextual factors that affect health. The pandemic also led to the highest overdose death toll since 2017. While we know that social isolation can amplify and reinforce OUD, it is unclear which components of SARS- CoV-2 mitigation efforts and resulting social, economic and healthcare disruptions differentially influenced individuals with existing/at-risk of OUD. Additionally, we do not know if the impacts were concentrated in communities with a higher pre-pandemic rate of OUD and/or were disproportionately adversely affected by economic factors or COVID-19 cases/deaths. The goal of this study is to leverage large comprehensive claims and electronic health data, capturing nearly half of the U.S. population from before the pandemic through 2026, to test our hypothesis that social and economic vulnerabilities, as well as economic side effects of the pandemic will escalate the prevalence of OUD and related harms. Building on our extensive existing work, we use quasi-experimental methods to measure adverse OUD-related outcomes and worsening health disparities using existing records capturing longitudinal OUD and COVID-19 incidence at the individual patient and community levels. In Aim 1, we evaluate whether OUD outcomes during the first nine months have been worse among communities that had been harder hit by the opioid epidemic pre-pandemic or have experienced disparately higher incidence of COVID-19 morbidity/mortality during the pandemic. In Aim 2, we evaluate longer-run OUD trajectories for communities that experienced 1) greater degrees of economic loss, 2) higher COVID-19 morbidity/mortality, and 3) have disparate levels of vaccination uptake over the first five years. We further examine disparities in OUD outcomes and leverage individual longitudinal data for particularly vulnerable subpopulations (pregnancy, adolescents, disability, older adults). At the successful completion of the proposed research, the expected outcomes are defined policy relevant factors that will reflect the net health and mortality impacts of the COVID-19 pandemic on OUD diagnoses, treatment initiation and adherence, utilization, and mortality over the short- and longer- terms. Ultimately, this research will support NIH NIDA’s goals, identifying COVID-19’s impact on OUD and populations at risk for being medically underserved in this complex yet vulnerable population.