Perspectives on COVID-19 and substance use

We’ve seen all this and more in the news over the past few months, and wanted to know more. We asked two OHSU experts on substance use – one health care provider, one researcher – to tell us what their seeing in their work.

Dr. Kea Parker, family medicine doctor and expert in addiction medicine

Over the past year, Dr. Parker has seen her patients with substance use disorders struggling.

Women who have been in treatment for a long time have been more likely to relapse. Some women are using drugs now they never used before.

“The worst part is that it’s harder for them to get the treatment they need,” Dr. Parker says. “Group therapy and coming to the clinic every day were important parts of treatment for many people, and they’ve lost that community during the pandemic.”

Dr. Parker is also seeing substance use, especially alcohol use, increasing among women who don’t have substance use disorders. Her concern is when women switch from using alcohol as part of a celebration or social activity to using it to cope with stress.

“That’s a big turn,” says Dr. Parker. “When you’re using a substance to cope, it becomes part of your routine. That leads to negative effects, including dependence on the substance.”

Even if it doesn’t to the point of physical dependence, emotional dependence can make you:

  • More socially isolated
  • Less likely to address mental health concerns like anxiety and depression
  • Less likely to find healthy ways to cope, like exercise, counseling, and spending time with family and friends.

We asked Dr. Parker for some advice for women who don’t have a substance use disorder but have seen their use of alcohol or marijuana increase over the past year. She says:

  1. Acknowledge the issue. If you or your friends or family have concerns, don’t ignore them.
  2.  Ask yourself if your use is affecting other parts of your life. Are you choosing substance use over exercise, family time or hobbies you used to enjoy?
  3. Talk to someone. A trusted family member, friend, health care provider, or counselor are all good options.
  4. Get outside. Making an effort every day to get sunshine, exercise, and be around other people is very impactful.

Dr. Milky Kohno, assistant professor of psychiatry at OHSU

Dr. Kohno is conducting a clinical trial for women with a methamphetamine use disorder (supported by funding from the OHSU Center for Women’s Health Circle of Giving). The COVID-19 pandemic forced Dr. Kohno to stop recruiting participants in the study for almost a year.

As of January 2021, recruitment is back underway, but it is much more challenging than before. It has been a very tough year for the women Dr. Kohno is seeking to recruit and she is getting far fewer responses than she was pre-pandemic.

In her conversations with women, Dr. Kohno is hearing firsthand the devastating effect that COVID-19 has had on their substance use issues.

Above all, they are using more methamphetamines to cope with additional responsibilities and stress.

“It used to be that these were single moms working two jobs and they were using the drug to stay energized, awake and alert all day. We call that a ‘functional’ use of the drug,” Dr. Kohno says. “Now they are using more and more to cope with stress, and that makes the addiction much scarier and harder to treat.”

It also leads to co-use of other drugs. After a day full of stimulants, many of these women are using alcohol and marijuana to help them relax in the evening. This terrible cycle gets worse as tolerance for all these drugs goes up.

Once schools re-open and women feel safe coming to the hospital again, Dr. Kohno will complete her study. She will use the data to build towards personalized addiction treatment for women. Her goal is to create an algorithm to connect women with the addiction treatment most likely to work for them.

After the pandemic

Will substance use rates go back down after the pandemic? Dr. Parker and Dr. Kohno agree that we don’t know yet, but they have concerns.

“For people who have become more isolated, it may be hard to re-engage in society,” says Dr. Parker. “And if alcohol or other drugs have become your coping mechanism, that’s a habit that’s hard to change.”