In Pennsylvania, Overdose Deaths Were Falling. Then COVID-19 Hit.

In 2017, more than 86 people in Cumberland County, Pennsylvania died from an overdose—a majority from opioid use. It was the highest overdose death count in the county’s history.

One year later, overdose deaths had fallen by nearly 40 percent in the county. The drop was welcome news to the community, which had traditionally lost fewer than 10 residents to overdose deaths in a year. The decline continued in 2019, falling another roughly 10 percent.

Then the COVID-19 pandemic hit. In March, Governor Tom Wolf began issuing countywide stay-at-home orders for individuals, and urged non-essential businesses to close. On April 1, Wolf issued a mandatory statewide stay-at-home order.

By the middle of April, more than one million workers in the state were suddenly unemployed. In Cumberland County, the unemployment rate went from roughly 4 percent in March to more than 12 percent in April.

And overdose deaths in the county spiked. As of June 3, more than 30 people have died this year from a drug overdose. The county is now on track to reach, and potentially eclipse, its 2017 high-water mark.

A similar situation is playing out in York County, where overdose deaths also peaked in 2017 and declined in 2018 and 2019. According to County Coroner Pamela Gay, 100 people in the county have died this year of an overdose, as of June 11—a roughly 75 percent spike in deaths this year to date. Fewer than 60 people died as a result of a drug overdose during the same time last year.

Philadelphia, which had the highest rate of overdose deaths in the entire state in 2017 and nearly the highest rate in 2018, is also experiencing an uptick in overdose deaths, advocates say. The latest public data on overdoses in Philadelphia is from March and shows a slight increase in hospital admissions compared to a month earlier.

“In this last month, I’ve lost five people who I was close to,” Carol Rostucher, president of Angels in Motion, a Philadelphia-based outreach program for people who use drugs, told The Appeal in late May. “I don’t think that’s ever happened to me before, never.”

Rostucher said COVID-19 and the subsequent lockdown have exacerbated the overdose crisis by forcing people into isolation and impeding access to treatment.

Through Angels in Motion, Rostucher visits with people who use drugs, delivers food and water to them, helps provide clean supplies, and educates them on safe use.

She said the lack of human contact created by the statewide lockdown and social distancing efforts has worn people down.

“A hug is really important. Meeting someone in person and talking with them is important,” she said. “When you don’t have that, it starts to get to you, and I see people who are more depressed than usual.”

This isolation and depression can lead people who are in recovery to begin using again, and push people who are currently using to use more as a way to escape, Rostucher said.

Because of social distancing guidelines, more people are also using drugs alone, which puts them at a higher risk of death. The drug naloxone has been found to reverse nearly 90 percent of overdoses, but someone must be on-site to deliver it to the user.

Rostucher said that while some restrictions on medication-assisted treatment have been relaxed because of COVID-19, many people are still required to visit a clinic every day or at least several times a week to get medication like methadone, a long-acting synthetic opioid prescribed to treat opioid use disorder.

According to Rostucher, many people who received medication-assisted treatment prior to COVID-19 were given bus fare as part of their treatment. That stopped when the Southeastern Pennsylvania Transportation Authority, which operates most public transportation in Philadelphia, limited its services and stopped charging bus fare at the beginning of the pandemic.

But in May, SEPTA mostly resumed its normal services and began charging bus fares again, leaving many people in need of treatment scrambling to come up with the money needed to get to their clinic, she said.

“Think about the frustration and think about their anger,” Rostucher said. “This is their medication they need every day, and no one is thinking of them and what they need. They’re just saying ‘oh, well, you’ll just have to figure out a way to get there.’”

People who receive Suboxone, an opioid treatment drug, encounter similar impediments, Rostucher said. Prior to COVID-19, people receiving Suboxone had to see a physician once a week. The restrictions on in-person visits were changed to once a month as a result of COVID-19, but people receiving the drug are required to have a telemedicine appointment once a week. For someone who is unhoused and doesn’t have a phone, the state’s response to COVID-19 can make that practically impossible.

In Pennsylvania, more overdose deaths could mean more prosecutions. Prosecutors in York and Cumberland counties have sought felony convictions for people who sell or share drugs when someone overdoses and dies. The conviction—drug delivery resulting in death—can carry a sentence of up to 40 years in prison. Skip Ebert, the Cumberland County district attorney who took office in 2018, has filed more drug delivery resulting in death cases in his first two years on the job than his predecessor did in his entire roughly 10-year tenure.

More than 30 states have seen a rise in opioid-related overdose deaths since the COVID-19 pandemic began, according to the American Medical Association, which issued a brief urging states to take proactive steps to prevent overdose deaths.

In New Jersey, overdose deaths jumped more than 15 percent in both March and April compared to the same time last year, and nearly 25 percent in May. Overdose deaths in Chicago rose from 461 during the first five months of 2019 to more than 920 during the same timeframe this year.

“It’s a lot of isolation, and that’s what feeds addiction, isolation,” Rostucher said.