HIGH-RISK OPIOID USE MEASURED AS INJECTION-RELATED DISEASE PREDICTABLY STALLS THEN SURGES OVER COVID YEARS
Experts’ findings confirm predicted trends for high-risk use: initial decrease tied to reduced exposure to standard treatments, then surge as medical opioids are increasingly, unsafely dispensed
by Clark Miller
Published January 29, 2023
Adding to a consistently congruent body of evidence, the new results match predictions: high-risk opioid use, as measured by incidence of injection-related infectious disease, was initially and partially moderated, reduced, in the first year of COVID when exposure of drug users to failed American substance use treatment; to risk- and harm-predicting involvement in the religious subcultures AA and NA; and to availability of the doctor-dispensed, addictive, diverted, opioids fueling high-risk use were protectively interrupted and/or limited due to COVID measures.
Take a look –
Availability of American standard addiction treatment including its no-fee provision in community settings was interrupted over the early months and through much of 2020 due to stay-at-home orders and COVID restrictions on public gatherings. The very restrictions implemented for COVID that limited in-person gatherings necessarily provided the predicted protective effect of reducing exposure of substance users vulnerable to continued use or resumption (“relapse”) of problem, high-risk use to those group meetings and America’s addiction treatment systems, established as predicting no benefit for substance use, instead increased risk of return to problem use.
Among the counter-therapeutic, risk-predicting features of addiction treatment, beyond no predicted benefit, the mutually triggering and socially reinforcing effect of in-person interactions with other users who are continuing use – or in the case of community meetings of the religious subcultures AA and NA predictably returning to problem substance use at the probability of 90 to 95 percent and are engaged in mutual, socially reinforcing use of the gateway (for alcohol and opioids) drug nicotine – predicts failure and return to problem use.
This is expected, no differently than it was predictable that prevalence of youth vaping would have (and did) decrease with school closures and stay-at-home orders isolating youth vapers from each other and social reinforcing and availability effects, vaping now rebounded with dissipation of COVID restrictions.
Initial COVID restrictions and interruptions formed barriers to continuous supply of the medically dispensed opioids (MAT opioids methadone and especially Suboxone) established as fueling high-risk opioid use and associated harms by diversion, misuse, and use as currency in street economies of illicit high-risk opioid use, including fentanyl.
Unlike the other meaningful measure of high-risk opioid use – nonlethal overdose – measurable effects of high-risk use as injection measured as medical encounters for endocarditis would be predicted to lag in observed effect due to disease course, consistent with a stalling of medical encounters for endocarditis recorded for 2020, then pronounced surge in 2021 and in 2022 (2022, over which fabricated COVID stressors as causal explanation for a worsening opioid crisis had dissipated, invalidating those necessary fabrications).
From accumulating evidence, the overcompensation for those perceived challenges – beginning by late April of 2020 the significant abandonment of longstanding safety controls on the medical MAT opioids already fueling the crisis, including suspension of clinical contact, of urine or other drug screens, initiation of dispensing by phone contact, other measures – has resulted predictably in more extensive and lethal results, medical providers reporting their continued dispensing of widely diverted and misused opioids with clinical uncertainty and suspicions of misuse.
Just as they have continued to recklessly misprescribe opioids other than MAT opioids.