Opioid use disorder (OUD) had been a serious national crisis that affected public health and economic welfare, even prior to the COVID-19 pandemic. The COVID-19 pandemic and the mitigation policies to prevent the spread of SARS-CoV-2 had upended social networks, healthcare access, led to historically high unemployment, and amplified pre-existing community and economic vulnerability. Communities of color had been hardest hit and highlighted pre-pandemic disparities in health, mortality, and well-being, including structural community contextual factors that affected health. The pandemic had also led to the highest overdose death toll since 2017.

While it was known that social isolation could amplify and reinforce OUD, it had been unclear which components of SARS-CoV-2 mitigation efforts and resulting social, economic, and healthcare disruptions had differentially influenced individuals with existing or at-risk OUD. Additionally, it was not known if the impacts had been concentrated in communities with a higher pre-pandemic rate of OUD and/or were disproportionately adversely affected by economic factors or COVID-19 cases/deaths.

The goal of this study had been to leverage large, comprehensive claims and electronic health data, capturing nearly half of the U.S. population from before the pandemic through 2026, to test the hypothesis that social and economic vulnerabilities, as well as the economic side effects of the pandemic, would escalate the prevalence of OUD and related harms. Building on extensive existing work, quasi-experimental methods had been used to measure adverse OUD-related outcomes and worsening health disparities using existing records capturing longitudinal OUD and COVID-19 incidence at the individual patient and community levels.