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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 24, Issue 4, 2021. Pages: 125-135
Published Online: 1 December 2021

Copyright © 2021 ICMPE.


PERSPECTIVE: Current US COVID-19 Pandemic Substance Use Research and Ideas for Research That May Help Us Learn More

Sarah Q. Duffy*

Ph.D., Associate Director for Economics Research, Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA

* Correspondence to: Sarah Q. Duffy, National Institutes of Health, 3WFN RM 08C54 MSC 6020, 301 North Stonestreet Ave, Bethesda MD 20892, USA. FedEx, UPS Address: National Institutes of Health. 3WFN RM 08C54 MSC 6020, 301 North Stonestreet Ave, Rockville MD 20850, USA.
Tel.: +1-301-451 4998
E-mail: duffys@nida.nih.gov

Source of Funding: The work was done as part of the author's official duties as a NIH employee.

Disclaimer: The views and opinions expressed in this manuscript are those of the author only and do not necessarily represent the views, official policy, or position of the U.S. Department of Health and Human Services or any of its affiliated institutions or agencies.

Copyright: The author is a federal employee at the National Institutes of Health. No content in this perspective may be copyrighted.

The COVID-19 pandemic has had and will continue to have severe implications for those who use addictive substances or have substance use disorders, and the services that address them. Research, particularly health economics research, can help illuminate these effects on individuals, learn the most from the rapidly imposed changes in policy and how services were delivered, and plan for future pandemics. This Perspective, which focuses on the United States context, identifies potential effects of COVID-19 and the pandemic mitigation policies, highlights themes in current research, and suggests areas for further inquiry.


Background: The COVID-19 pandemic likely had and will continue to have severe implications for those who use addictive substances, have substance use disorders, or use substance use related health care services. Policy and services research, particularly health economics research, can illuminate these effects on individuals, uncover the effects of the rapidly imposed changes in policy on how services were delivered, promote efficient and effective provision of services, and inform responses to future pandemics.

Aims of the Study: To identify potential substance use related effects of COVID-19 and pandemic mitigation policies, highlight themes in current research, and suggest areas for further high-quality policy and services research, with an emphasis on health economics research.

Methods: Review of recent published commentaries, government documents, and initial research findings to describe potential impacts, and review of current COVID-19 related research grants funded by the United States National Institutes of Health to identify themes.

Results: Potential impacts include increased risk for and severity of COVID-19 illness among those who use substances, mitigation measures causing increased substance use and development of use disorders, and fundamental changes in the way treatment is provided. Current research may provide initial findings that may be useful in generating hypotheses for future rigorous research.

Discussion: Research on these and other areas could enhance our fundamental understanding of the needs of individuals who use substances and how to best address those needs in the most efficient, effective way. Though this brief review highlights some areas of potential interest, its focus is mainly on treatment and on the United States context. Research on additional services and contexts likely could inform advances as well.

Implications for Health Care Provision and Use: Health care providers rapidly and under considerable stress made needed changes that likely mitigated SARS-CoV-2 transmission. Rigorous research can help determine what worked best and for whom, what could be kept, and what might better be discarded.

Implications for Health Policies: Research on the effects of mitigation policies may inform the development of policies to reduce negative effects when addressing future pandemics, whether to permanently allow at least some substance use treatment flexibilities, and whether research on other restrictive policies might lead to improvement.

Implications for Further Research: This extraordinary event brought into sharp relief the numerous vulnerabilities of those who use substances and those with substance use disorders while also leading to vast changes in the services that address them. Rigorous research into those effects could result in significant improvements in policy and practice.

Received 5 June 2021; accepted 14 October 2021

Copyright 2021 ICMPE