College of Public Health

CRHR Authors Article on COVID-19 and Substance Use Disorders


Kate Beatty and Michael Meit, faculty in the East Tennessee State University College of Public Health’s Center for Rural Health Research, have co-authored an article in the Journal of Appalachian Health.  The article, Rural Appalachia Battling the Intersection of Two Crises: COVID-19 and Substance Use Disorders, discusses rural Appalachia’s great risk of unforeseen side effects of the COVID-19 pandemic, including increased mortality from substance use disorders.

Margaret Miller, alumna of East Tennessee State University’s MD/MPH program, is lead author of the article.  Rebekah Rollston, co-author, is also an alumna of this joint degree between the College of Public Health and the Quillen College of Medicine.

In the midst of the COVID-19 pandemic, rural Appalachia is at risk for previously unforeseen side effects from the COVID-19 pandemic, itself, and from physical distancing, social isolation and other actions implemented to contain the virus.  These side effects appear to include increased mortality from substance-use disorders. In 2015, drug overdose mortality rates in Appalachia were 65% higher than the national average, driven largely by opioid use. While rates had declined, over the ensuing years, drug overdose mortality rates in Appalachia remained 48% higher than the national average in 2018, the most recent year of data available.

Since that time, preliminary data from the Centers for Disease Control and Prevention show rising drug overdose mortality rates nationally, and anecdotally, partners in Appalachia attribute those most recent trends to the impact of the COVID-19 pandemic.  People living with substance use disorders are at increased risk for both exposure to, and poor outcomes from, COVID infection.  They also experience homelessness and incarceration at greater rates than the general population, making physical distancing difficult or impossible, placing individuals at increased risk for COVID-19 exposure and transmission. Other risks associated with substance use disorders include poverty, housing and food insecurity, lack of access to health care, and complex chronic conditions, all of which can be exacerbated by COVID-19.  

As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, policymakers must take into account the pre-existing  geographic, economic, health, and social inequities within the region.