A Qualitative Study on the Impact of COVID-19 on Overdose Risk from the Perspective of Survivors and Witnesses of Drug Overdose: Lessons for Future Public Health Emergencies

Authors

Hridika Shah, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Sara Whaley, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Isha K. Desai, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Minna Song, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Avery Meyer, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Omeid Heidari, Department of Child, Family, and Population Health, University of Washington School of Nursing, Seattle, Washington, USA.
Sean T. Allen, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States.
Noa Krawczyk, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.
Susan G. Sherman, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States.
Brendan Saloner, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Samantha J. Harris, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Document Type

Journal Article

Publication Date

9-30-2025

Journal

Substance use & misuse

DOI

10.1080/10826084.2025.2562455

Keywords

COVID-19 pandemic; Opioid use disorder; drug overdose survivors; overdose risk; qualitative research

Abstract

INTRODUCTION: The COVID-19 pandemic had a devastating impact on people who use drugs (PWUD). Reductions in access to harm reduction tools and treatment services elevated rates of fatal overdose for many. We explore the mechanism through which these factors influenced the rise in overdose mortality during COVID-19 from the perspective of people with overdose encounters. METHODS: We conducted in-depth, semi-structured, 60-minute telephone-based interviews with 43 overdose survivors and witnesses between January and May 2022. Participants were from nine states (ME, MI, MD, NJ, NY, NM, PA, TN, WV) and Washington, DC. Data were analyzed thematically following the Continuum of Overdose Risk. RESULTS: Most reported worsening mental health and increasing substance use during COVID-19. Isolation due to quarantining measures, coping behaviors, despair, and traumatic grief contributed to resumptions in drug use and risky behaviors. Some discussed how these stressors, combined with the rapid availability of financial resources led to increased use. Participants also attributed increased overdose risk to the increasingly toxic drug supply and stifled harm reduction access. Accounts of methadone treatment varied, however several expressed inconsistent access to take-home methadone, potentially contributing to resumed use. CONCLUSIONS: Numerous micro- and macro-social factors, as well as the drug supply and treatment disruptions contributed to the acceleration in overdose risk. Increased funding and policy reform are needed to reduce overdose mortality in future public health emergencies, including improving harm reduction and treatment service adaptations to fit the needs of clients, as well as upholding and expanding novel methadone treatment delivery models.

APA Citation

Shah, Hridika; Whaley, Sara; Desai, Isha K.; Song, Minna; Meyer, Avery; Heidari, Omeid; Allen, Sean T.; Krawczyk, Noa; Sherman, Susan G.; Saloner, Brendan; and Harris, Samantha J., "A Qualitative Study on the Impact of COVID-19 on Overdose Risk from the Perspective of Survivors and Witnesses of Drug Overdose: Lessons for Future Public Health Emergencies" (2025). GW Authored Works. Paper 7879.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7879

Department

School of Medicine and Health Sciences Student Works