There is no question that COVID-19 has had a devastating impact on every aspect of society, from our mental health and physical well-being to the economy. The stressors seem endless and almost unbearable — and for many, they are. The pandemic has had far-reaching effects on drug use, detection and treatment including increased use of illicit drugs and the scaling back of drug testing programs. These effects have been worsened by the fact that having a substance use disorder also puts workers at an increased risk of severe complications from the virus.

Drug Testing Has Been Scaled Back

Many employers curtailed or postponed drug testing in response to the first wave of the virus and initial lockdowns in the spring of 2020. Testing for COVID-19 has reduced drug testing availability at many occupational health facilities, as they focus on the pressing need to complete the required mass of COVID-19 tests. Some employers are also reluctant to put their workers at further risk by sending them to these facilities.

One response has been to postpone pre-employment drug testing until a later, often vague and uncertain date. Experts point out that this could be problematic, as California, and several other states, have stringent rules regarding how and when pre-employment drug tests can occur.

With a more relaxed attitude toward cannabis use across the U.S., many employees have chosen to eliminate testing for this drug. However, it is essential to note that even though the Department of Transportation has declared itself flexible, its drug testing requirements have not changed, including testing for cannabis use. One solution to meeting DOT requirements is the use of mobile testing services, which can be brought to the worksite and serve as an alternative to sending employees to other labs.

More Workers Are Testing Positive

Numerous studies have pointed to an increase in positive drug test results in most states, and according to at least one, no state has experienced a decrease in positive tests. One of the most problematic of these statistics is the increase in use of cocaine, fentanyl, heroin and methamphetamines.

This means that employers will likely be dealing with the aftereffects of the pandemic, particularly related to substance abuse, long after it is over. Preparing for these effects while keeping all workers and the public safe is likely to translate into changes to workplace drug and alcohol policies, increased testing and enhancements to existing supports.

Drug Use Is Growing

There is growing evidence that the pandemic had led to an increased reliance on drugs for many, both legal and illegal. Medical marijuana sales in Arizona increased by more than 30% in May 2020 while sales of both recreational and medical cannabis hit a record high in Colorado in that same month. Alcohol sales are also up. The alcohol industry reported a 27% increase in sales.

As mental health issues such as anxiety and depression grow, people may also be self-medicating. The Centers for Disease Control (CDC) reported that 13.3% of respondents to a recent survey on these disorders had either started or increased their substance abuse. Front line professionals also report that COVID-19 has led to an increase in opioid use and relapses.

Work from Home Set-Ups Create Further Complications

Remote work is further complicating drug testing for employers. In the spring of 2020, initial lockdowns made it difficult for companies to demand and complete drug tests and some postponed drug testing completely.

As the pandemic has dragged on, though, employers have had to become more creative in their approaches. Point-of-collection tests, for example, can be performed by the employer and can provide immediate results which are then sent to a lab for confirmation testing. Oral fluid tests, which require only a swab, are some of the most popular of these type of testing methods.

These tests can also be self-administered by employees remotely over videoconference with a health professional. These can be problematic to administer, however in a reasonable suspicion case.

There are a few additional considerations for employers who plan to test their remote workers during the pandemic:

• Communicate safety protocol expectations for employees who are asked to visit testing facilities.
• Consider expanding or clarifying your drug testing policy’s definition of a 'workplace.'
• Carefully assess any refusal to test for legitimate safety concerns and consider possible accommodations.
• Train supervisors to look for signs of impairment from remote workers.

Recovery Has Become More Challenging

For those already suffering from a substance abuse disorder, COVID-19 makes the recovery and rehabilitation process much more difficult. Treatment centers may be temporarily closed or operating at limited capacity. Access to trained counsellors and other professionals may also be restricted or handled via remote means such as videoconferencing, which may not be ideal for everyone. COVID-19 is also exacerbating existing stressors, including physical, mental and economic issues for vulnerable people, making it much more challenging for individuals to get better.

Additionally, the forced isolation associated with the pandemic compromised the mechanisms that would typically catch substance abuse in its early stages. Supervisors or family members may be less likely to notice problems, friends may be visiting less, etc.

Substance Abuse Sufferers Are More Likely To Become Seriously Ill

Substance abuse disorders are serious illnesses themselves, but someone suffering from a substance abuse disorder is also much more susceptible to COVID-19 and much more likely to suffer severe outcomes from the virus. A study published in Molecular Psychiatry that examined electronic health data from 73 million U.S. patients, revealed some startling statistics:

• Patients with substance abuse disorders made up 15.6% of all COVID-19 patients (compared to 10.3% of all patients)
• Patients with a recent opioid use disorder diagnosis were 10.2 times more likely to have COVID-19
• Other recent use disorders also put patients at higher risk of contraction COVID-19, including tobacco (8.2 times), alcohol (7.8 times), cocaine (6.5 times) and cannabis (5.3 times)
• Those with lifetime substance abuse disorder diagnoses were 1.5 times more likely to contract COVID-19.
• Patients with substance abuse disorder diagnoses were also 11% more likely to be hospitalized and 3% more likely to die from complications of COVID-19.

Experts point to numerous reasons. Many illicit drugs weaken immune systems and harm the lungs, heart and even brain, making people more vulnerable to the virus. Social interactions related to drug use, such as sharing needles or interacting with dealers and other users can also put certain groups at a higher risk.

The Takeaway

The pandemic's effects on both drug users and their employers are likely to be lengthy and far-reaching. Tackling these effects will require patience and planning.