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The opioid epidemic, COVID-19 pandemic, and the Opioid Agonist & Safety Study

Nikky Jones
image - Nikky Jones 1

Globally, the opioid epidemic has not gone away, it has merely been muted by COVID-19. We have been very fortunate in Australia, but in countries such as Canada, the UK and the US it is a very different story.

COVID-19 has led to increased social isolation and reductions in face-to-face appointments with healthcare workers, so it’s no surprise that harm due to opioid use disorder is on the increase in countries more severely impacted by COVID-19. A recent report in the Guardian quoted Dr Mike Brumage, former director of the West Virginia Office of Drug Control Policy, comparing COVID-19 with the opioid epidemic:

“It’s (COVID-19) robbed the oxygen out of the room and made it the sole focus of what’s happening. There’s also a fatigue about the opioid crisis. You can think of COVID-19 as a hurricane whereas the opioid crisis is more like global warming. It’s happening, it’s slow, it’s dangerous, but it’s not happening at the same speed and scale as the coronavirus is having right now.”

The State of Michigan has a surveillance system for opioid overdose, SOS, and has observed an increase of 15 per cent in the number of fatal overdose for the period March-September 2020, compared with the same period in 2019. The State of Michigan is not alone; an estimated 13 per cent rise in deaths from drug overdose has been reported across several local and state governments in the US, with some reporting an increase as high as a 30 per cent1.

More needs to be done to identify behaviours of increased risk and develop strategies for intervention. Last year researchers at NDARC explored linked administrative data for the Opioid Agonist Treatment and Safety Study (OATS). The aim of the study is to quantify the risk of adverse events for people with a history of Opioid Agonist Treatment (OAT), the most effective treatment for opioid use disorder. The study cohort includes all people administered OAT in NSW between 2001 and 2018. 

The Data Resource Profile paper2 for this study was published in November 2020. This paper describes the study cohort which has been the basis of some previously published analyses: life expectancy3 of people with a history of OAT, those discharged against medical advice4, trends in clinician retention5, and trends in non-fatal overdose6.

image - The opioid epidemic, COVID-19 pandemic, and the Opioid Agonist & Safety Study

At least 2/3 of this cohort had experienced a hospitalisation with the ICD-10 diagnosis code associated with mental and behavioural disorders due to opioids; the next most common diagnoses were injury and liver disease.

As can be seen above, this cohort already places high demands on healthcare systems, which are now increasingly overburdened and understaffed due to COVID-19. This Australian study has the capacity to inform the US of possible interventions or process improvements to help in their response to the opioid crisis in North America. This could include identifying risky, non-opioid, behaviours prior to overdose, identifying risks in prescriber and dispensing accessibility, providing mental health support when first responders are called or on admission to emergency departments, and making naloxone more easily accessible.

In work published from this latest cohort the differences in rates and substances involved by sex, age and over time provide support that evidence-based interventions for overdose prevention need to be delivered to scale.

The OATS study highlights that we cannot be complacent about advancing our research and treatment capacity for opioid dependence, especially in a health crisis that demands so much from the health system.

Where can I find more information about this study?

If you’d like to read the full paper or have any questions about this study, please contact Nikky Jones at nicola.jones@unsw.edu.au or visit the OATS website: https://ndarc.med.unsw.edu.au/project/opioid-agonist-treatment-and-safet....


  1. Wen LS, Sadeghi NB. The opioid crisis and the 2020 US election: crossroads for a national epidemic. Lancet 2020.
  2. Larney S, Jones N, Fiellin DA, et al. Data resource profile: The Opioid Agonist Treatment and Safety (OATS) Study, New South Wales, Australia. Int J Epidemiol 2020.
  3. Lewer D, Jones NR, Hickman M, Nielsen S, Degenhardt L. Life expectancy of people who are dependent on opioids: A cohort study in New South Wales, Australia. J Psychiatr Res 2020; 130: 435-40.
  4. Lewer D, Jones NR, Hickman M, et al. Risk of discharge against medical advice among hospital inpatients with a history of opioid agonist therapy in New South Wales, Australia: A cohort study and nested crossover-cohort analysis. Drug Alcohol Depend 2020; 217: 108343.
  5. Jones N, Nielsen S, Farrell M, et al. Retention of opioid agonist treatment prescribers across New South Wales, Australia,2001-2018: Implications for treatment systems and potential impact on client outcomes. Drug Alcohol Depend (in press).
  6. Jones NR, Hickman M, Larney S, et al. Hospitalisations for non-fatal overdose among people with a history of opioid dependence in New South Wales, Australia, 2001-2018: Findings from the OATS retrospective cohort study. Drug Alcohol Depend 2020: 108354.