Qualitative Assessment of the Impact of COVID-19 and Transmission Mitigation Policies on Individuals with Substance Use Disorders in NYC

Abstract: SARS-CoV-2 and the resulting coronavirus disease (COVID-19) is causing significant morbidity, mortality, and widespread challenges for our healthcare and other societal systems. Through both direct health consequences and the indirect effects of policies implemented expeditiously to “flatten the cure,” vulnerable populations of people, such as individuals with substance use disorders (SUD), have likely been disproportionately impacted. Patients with already compromised lung functioning, such as individuals who smoke or vape substances, or with underlying health problems as a result of addiction, may be at higher risk for more severe complications from COVID-19. Physical distancing measures have put significant limitations on access to substance use treatment and mutual support resources. While the early deployment of virtual support meetings, telehealth, and the option of take-home medications for some people may lessen negative outcomes, very little is known about how this environment will ultimately effect individuals with SUD. The Substance Treatment and Research Services (STARS) clinic at Columbia has been completing medical and psychiatric assessments and providing treatment through clinical trials for a large cohort of individuals with a range of SUD prior to COVID-19. New York City is an epicenter of the pandemic. STARS, by nature of its location and the patients it has served over the years, has a unique opportunity to elucidate answers to some of these questions. An overarching goal of our group is to understand the impact of COVID-19 and “shelter in place” policies, as it relates to medical, psychiatric, and substance use outcomes in individuals with cocaine, cannabis, opioid, nicotine, and alcohol use disorders in NYC.

Specific Aims: Aim 1: To assess presumed and confirmed COVID-19 diagnosis, course of illness, and medical consequences for individuals with SUD in NYC. Aim 2: To assess the impact of transmission mitigation policies in NYC on individuals with SUD as it relates to mental health and substance use outcomes and access to treatment. Exploratory aims: Assess the impact of school closures, unemployment, and other social changes on substance use and mental health as a result of COVID-19. Methods: We will contact previous STARS participants by phone and complete initial qualitative interviews to assess presumed and confirmed COVID-19 diagnosis, COVID-19 course of illness and treatment, and medical consequences. Additionally, we will assess participants’ substance use and mental health, as it relates to mood and anxiety, during the pandemic and their ability to access treatment, mutual support groups, and other resources (clean needles, etc), during stay-in-place orders. Finally, we will ask participants about the effects of school closures and possible unemployment as it relates to mental health, substance use, and overall safety and stability. Following this initial interview, we will complete two subsequent interviews at 6 and 12 months, to assess longitudinal effects.