Are we Truly “Safer-At-Home”? A Test of Contextual Effects on Mental Health and Drug Overdose Incidents During the COVID-19 Pandemic

• Date: 01 July 2022
• DOI: 10.1177/00220426211073912
• Author: Rebecca Headley Konkel,Michelle N. Harris,Chrystina Y. Hoffman
• Published date: 01 July 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(3) 349–365

© The Author(s) 2022

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DOI: 10.1177/00220426211073912

journals.sagepub.com/home/jod

Are we Truly “Safer-At-

Home”? A Test of Contextual

Effects on Mental Health and

Drug Overdose Incidents

During the COVID-19

Pandemic

Rebecca Headley Konkel

1

, Michelle N. Harris

2

, and

Chrystina Y. Hoffman

3

Abstract

This study examined whether the social restrictions stemming from COVID-19 impacted the

locations of mental health and drug overdose incidents, while controlling for immediate and

community contextual indices. Addresses for mental health/overdose calls to law enforcement or

emergency medical services between January 1, 2018 and August 13, 2020 were collected from

one police department in the Midwestern United States. Businesses and previous victimization/

offending were joined with parcels (level-1; N = 20,019), whereas local services and socio-

economic indicators were joined with block groups (level-2; N = 32), to allow for a multi-level

(HLM7) examination of context on mental health/overdose incidents. Event Rate Ratios (ERR)

revealed the greatest contextual effects took place following social distancing mandates. Findings

highlight the importance of allocating to areas with the highest likelihood of reporting incidents

and suggest that parcels with a history of sex offenses, drug offenses, and prior mental health calls

may benef‌it the greatest from preventative resources.

Keywords

COVID-19, drug overdoses, drug use behaviors, mental health, neighborhoods, safer-at-home

order, service providers, victimization

1

University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA

2

The University of Texas at Dallas, Richardson, TX, USA

3

University of West Florida, Pensacola, Florida, USA

Corresponding Author:

Rebecca Headley Konkel, Department of Criminal Justice andCriminology, University of Wisconsin-Milwaukee, 2400 E.

Hartford Avenue, Milwaukee, Wisconsin 53211, USA.

Email: rkonkel@uwm.edu

The high contagion of the novel coronavirus (i.e., coronavirus disease, COVID-19) (World Health

Organization, 2020) has led to unprecedented social distancing efforts across the world, resulting

in unique barriers to service acquisition. Although the physical health impacts stemming from this

virus have unfolded quickly, our understanding of the impact of restrictions resulting from this

virus remain in the largely unknown. Due to social distancing, as well as the attenuation in access

to resources critical to support and coping, it is posited that such ramif‌ications have in f‌luenced the

public’s social well-being, including mental health and drug use behaviors. The restrictive

measures resulting from the COVID-19 pandemic have had many unintended consequences.

Specif‌ically, there has been an increase in symptomology associated with anxiety and depression,

suicidality, substance use, and opioid overdoses following social distancing mandates (e.g.,

“Safer-at-Home”order) (Czeisler et al., 2020;Mazza et al., 2020;Slavova, Rock, Bush,

Quesinberry, & Walsh, 2020;Weisler & Chrisman, 2020).

In addition to these unintended consequences, restrictions resulting from the COVID-19

pandemic have also introduced unique barriers to service utilization, highlighting the importance

of using technology to deliver mental health care (Weisler & Chrisman, 2020). Unfortunately,

some efforts may place individuals at greater risk for suicide or drug overdose. Pharmacies, for

example, are dispensing higher volumes of prescription medications to patients (e.g., 90-day vs.

30-day supplies) (Weisler & Chrisman, 2020), although mental health providers were generally

unable to have face-to-face consultations or appointments with patients. Additionally, following

Secretary Azar’s declaration of COVID-19 as a public health emergency, the Drug Enforcement

Administration (2020) approved prescribing controlled substances to patients without an initial in-

person medical evaluation. Although such procedures are aimed at streamlining the obtainment of

prescriptions while minimizing the need for face-to-face contact between practitioners and pa-

tients, the heightened accessibility to larger volumes of prescription drugs may inadvertently lead

to an increased risk of drug overdoses among consumers.

Given that COVID-19 has introduced mental health and drug use concerns, it is important to

note that the literature has established the intersectionality of mental health and drug use. Here,

people with mental disorders often use illicit substances at disproportionately higher rates (Gregg,

Barrowclough, & Haddock, 2007;Sareen, Chartier, Paulus, & Stein, 2006) with high comorbidity

between mood and anxiety disorders and drug dependence disorders (Conway, Compton, Stinson,

& Grant, 2006). For example, a study conducted by (Sareen et al., 2006) found that individuals

with anxiety disorder diagnoses are more likely to report lifetime stimulant, cocaine, hallucinogen,

and heroin use compared to those without anxiety disorders diagnoses. Further precipitating the

melding of mental health and drug use behaviors, people with mental illnesses are also at increased

risk for drug-related overdoses, with certain symptoms of mental illness (e.g., hopelessness and

depression) linked with higher odds of drug use/overdose (Turner & Liang, 2015).

As the current social restrictions are unprecedented in this modern era, it is essential to not only

identify potential associations between these restrictions and social outcomes, but also, how these

restrictions may be particularly dangerous to those with mental health or drug use histories. This

study contributes to the existing literature by examining the relationship between several con-

textual variables on mental health and drug overdose incidents. Moreover, because these social

restrictions have cut-off pathways of coping support systems, we identify how sexual victimi-

zation and prior mental health incidents are tied to overdoses. In addition, we include a measure

ref‌lecting previous drug offenses to capture drug history. Further, we examine whether these

effects vary following the social restrictions following the “Safer-at-Home”order. Through the

recognition of how social restrictions have impacted the locations most likely to experience mental

health and drug use behaviors, it may be possible to delegate valuable personnel and resources

more effectively and eff‌iciently towards those initiatives in need of the most support.

350 Journal of Drug Issues 52(3)