When COVID-19 first became a national emergency in March of 2020, many predicted that the situation could have a serious impact on Americans dealing with addiction. They were right.

Two years into the global coronavirus pandemic, America’s overdose crisis has worsened, and alcohol-related health problems are on the rise. But there have also been glimmers of hope. Here are some of the biggest developments from the past two years.

Overdose deaths are at record highs, largely due to synthetic opioids.

According to the CDC, the 12-month period ending in April 2021 saw over 100,000 overdose deaths. That’s a new record. Powerful fentanyl analogues have been contaminating the illegal drug supply during the pandemic, which has made drug use much riskier and deadlier.

Stimulant use and polysubstance use are on the rise.

CDC also reported significant increases in the use of cocaine and methamphetamines. In many overdose deaths, multiple substances were present, not just synthetic or prescription opioids.

Alcohol use is way up, too.

A national survey found that Americans’ excessive drinking increased during the pandemic by as much as 21%. According to research published in Hepatology and reported on by the Harvard Gazette, just a one-year increase in this kind of drinking will result in “8,000 additional deaths from alcohol-related liver disease, 18,700 cases of liver failure, and 1,000 cases of liver cancer by 2040.”

Black and Native Americans are dying from overdoses at higher rates than white Americans.

According to research published in JAMA Psychiatry and reported on by NPR, overdose deaths among Black Americans have surpassed those of white Americans. And not just during the COVID pandemic—this trend has been emerging over the past 10 years. Racism continues to fuel disparities: white Americans with addiction are more likely to be offered treatment, while Black Americans with addiction are more likely to be arrested and criminalized.  

The overdose death rate during the COVID-19 era has been highest among Native Americans, and this population is more at-risk for overdose deaths involving stimulants like meth.

For this group, Associated Press reports, “COVID-19 piled yet more despair on communities already confronting generations of trauma, poverty, unemployment and underfunded health systems.”

Health system strain, economic stress, and mental health struggles have made the addiction crisis worse.

There are several systemic factors that have made the COVID era so difficult for people with addiction.

The pandemic has put an enormous strain on our healthcare system.

Accessing care during this time for any health issues unrelated to COVID-19, including addiction services, has become increasingly difficult and stressful. And in the earlier days of the pandemic, with stay-at-home orders keeping Americans locked down at home, drug use became riskier and instances of relapse became more common.

Economic stress has likely also contributed to rising substance use.

Amid lockdowns and layoffs, people who’ve struggled with addiction lost jobs that not only provided income, but also social stability. Financial stress, as well as the loss of a satisfying daily routine, can increase the risk of addiction or overdose.

Amid global loss and uncertainty, many people have struggled with their mental health at unprecedented rates.

Since mental health and drug use are so closely linked, this has likely also impacted the rate of drug overdose deaths.

The COVID era has also shown some unexpected glimmers of hope.

Access to telehealth and methadone has improved.

For example, early in the pandemic, health systems and insurance providers quickly embraced telehealth services. This pivot could have lasting positive impacts in the addiction space, especially for Americans who live in rural areas where accessing services can be challenging. It’s also shown how, when needed, it’s possible to make big, rapid shifts in approach to save lives. That type of energy could really help as our country continues to reevaluate and revolutionize its approach to treating addiction.

Also, many opioid treatment centers have adapted their practices, allowing take-home doses of methadone. Despite concerns about diversion, studies show these relaxed practices did not increase negative outcomes. In fact, many experts argue that these practices, which make it easier for patients to initiate and stick with methadone treatment, should continue after the pandemic.

Harm reduction awareness is growing.

With such a dangerously contaminated drug supply, there’s never been a greater need for safety measures like naloxone and fentanyl test strips. The idea is catching on, with greater public awareness of overdose first aid, the importance of clean needles and other supplies, and more.

President Biden’s agenda for addressing the addiction crisis includes support and funding for harm reduction services at the federal level for the very first time. Cafes and nightclubs are keeping naloxone behind their counters and fentanyl testing strips in their bathrooms. New York became the first American city to open an overdose prevention center. Through programs like these, more Americans can survive addiction and ultimately chart their own course toward recovery.

Two years later, the COVID-19 pandemic continues to impact our daily lives.

By taking stock of what this pandemic has cost us, as well as identifying the positive ways we’ve adapted, we can figure out new ways to support all Americans—especially those living with or in recovery from addiction.