The Collision of COVID and the Opioid Epidemic: Grand Rounds 2022


When: This event originally occurred on January 7th, 2022.

Presenter: Dr. Greg G. Davis - Professor and Director of the Forensic Division of the Department of Pathology, University of Alabama at Birmingham

The opioid epidemic in the United States began in the late 1990’s and accelerated around 2015. SARS-CoV-2, the virus that causes COVID, first infected humans in late 2019. COVID has become a pandemic causing over 5 million deaths world-wide. COVID has caused over 780,000 deaths in the United States since the pandemic began, making the United States the only industrial nation that has the highest death rates from both COVID and from opioid toxicity.

Infectious epidemics and pandemics are regular features of human existence. The bubonic plague killed a third of the world’s population, but the bubonic plague and other pandemics spread when travel was difficult or uncommon. Easy travel in a global economy has allowed COVID to cover the world in weeks rather than years. The Omicron variant of SARS -CoV-2 was discovered in November 2021; three weeks later it had been detected in 60 countries on every continent except Antarctica.

Humans have used intoxicating substances for millennia. Literature records intoxication in all its phases, from the pleasant sensations of mild inebriation to the potentially deadly effects of profound intoxication. Businesses dealing in the transport and sale of intoxicating substances, whether legitimate or illegal, are as old as civilization and generally profitable.

In 1995 the American Pain Society began a campaign for treating pain that included the call to consider pain as the fifth vital sign, a concept that the American Pain Society trademarked. Physicians were assured that evidence showed that opioids used for treating pain did not lead to opioid addiction. Over the next five years various national and federal agencies endorsed this campaign, and the United States Congress declared 2000 to be the initial year of a “Decade of Pain Control.” Deaths from opioid toxicity began to climb steadily. By 2010, deaths from drug toxicity had quadrupled since 2000, mostly due to prescription opioids. Various agencies rescinded their endorsement of the campaign for pain control. As physicians stopped prescribing opioids for pain so freely, addicted individuals turned to illicit sources for the opioids that their bodies now depended on. Heroin was the main illicit opioid available in the mid 2010’s, but within a few years fentanyl supplanted heroin as the most commonly available opioid on the streets. Fentanyl is cheaper to manufacture and more potent than heroin, making fentanyl the obvious choice for distribution by drug cartels. Fentanyl soon surpassed all other opioids in causing death, and 2019 saw more deaths from drug overdoses than any preceding year.

COVID appeared in the United States in 2020, closing businesses, sending people to shelter in their homes, and preventing social interaction (e.g. nursing home visits). Based on data from the decades prior to the 21st Century, economists had posited that increased unemployment was associated with decreased drug use, but the COVID era belied that thought. COVID increased unemployment, but overdose deaths also increased, rising 29% from the previous record in 2019.

The COVID pandemic and the opioid epidemic are adversely affecting the health of the American public, and both demand much of public health programs. COVID has turned attention to inequities in health care in the United States. Public health initiatives focus on understanding risks for illicit drug use – stressful life events, areas of poverty, and lack of opportunity, in a word, hopelessness. Governments can work to create “opportunity structure” to redress imbalances in opportunity, giving individuals agency and a reason to live beyond the useless goal of getting high again tomorrow. On the individual level, disability and chronic pain are associated with isolation and depression, creating a feedback loop that can descend into death by overdose or suicide. Overcoming isolation and hopelessness requires committing ourselves to reach out to others, replacing isolation with community.

Detailed Learning Objectives:

  • Attendees will be able to identify the United States’ place in the world with respect to death rates from both COVID and opioid toxicity.
  • Attendees will be able to discuss the development of the opioid epidemic in the United States.
  • Attendees will be able to discuss the relationship of deaths caused by COVID to deaths caused by drug overdoses in light of economic theories of unemployment and drug use.
  • Attendees will be able to contrast public health initiatives to address risks for illicit drug use at the societal and individual levels.


*Funding for this training was made possible by a cooperative agreement between the National Network of Public Health Institutes and the Centers for Disease Control and Prevention [6 NU38OT000303-03-02]. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Centers for Disease Control and Prevention nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.


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