NDEWS COVID-19 Response


The current COVID-19 crisis demonstrates a need for rapid assessments of the virus’s impact on people who use substances. People who use drugs––particularly those who use opioids, methamphetamine, or other psychostimulants––appear to be at increased risk for COVID-19 adverse outcomes.

  • Available data have indicated that COVID-19 has a higher case fatality rate among persons with underlying health conditions such as respiratory diseases, which are prevalent among people who smoke and who experience substance use disorders.
  • In addition to increased risk for COVID-19 complications, people with substance use disorders––especially those with opioid use disorder––may also be at increased risk for overdose. Due to physical and social distancing measures, opioid overdoses may occur without the presence of observers who could have administered naloxone to reverse them.
  • Respiratory disease has also been shown to increase the risk for fatal opioid overdose, which means that those with opioid use disorder may be at increased risk due to compromised lung function from COVID-19.
  • Persons with substance use disorder who already face marginalization by health care workers may also find it more difficult to get care and access resources during the COVID-19 crisis, as they may be deprioritized for care in a strained health system due to existing stigma.
  • Physical and social distancing measures add additional challenges to those seeking medications for opioid use disorder, syringe services, naloxone, or other services provided by many syringe exchange services.

To rapidly improve our understanding of the impacts of COVID-19 on drug-related mortality, health services, drug treatment programs, and syringe exchange services, the NDEWS Coordinating Center will be conducting systematic, semi-structured interviews with three groups of key informants in all 18 sentinel sites: funeral directors, emergency medical services (EMS) personnel, and syringe exchange program (SEP) workers.

Each key informant group has unique knowledge about overdoses, drugs used, and other consequences of COVID-19 that are not easily obtained elsewhere or would not be knowable for some time. Results and identified themes can confirm conclusions drawn from available quantitative data as well as guide new research and prevention efforts.

Baseline interviews will measure community changes retrospectively, by comparing current events to previous events, and subsequent follow-up interviews will measure changes prospectively, by examining how events change during the COVID-19 crisis. Findings will be rapidly disseminated via peer-reviewed publications, webinars, and media outreach.

Key Informant Groups

Emergency Medical Service Personnel


EMTs and paramedics are at the intersection of COVID-19 and opioid overdoses. One study reported that EMS personnel responded to six times as many suspected opioid overdoses than evaluated by their city’s medical examiner. This puts EMTs at the forefront of an area’s COVID-19 response and gives the medical personnel the unique ability to provide high-quality accurate data that will evolve with our nation’s response to this epidemic.

The NDEWS team specifically curtailed this study to try to answer two questions: What is the impact of COVID-19 on overdose reversals, and what is the virus’s impact on emergency health services for persons with substance use disorders?

Syringe Exchange Programs


Due to COVID-19, some syringe exchanges have been closed, while others have been classified as essential workers and continue to operate. Our study will interview these essential workers to gain their perspective on COVID-19’s effects on drug use, overdoses, and services utilization.

Funeral Directors


Funeral directors have been called the “last responders,” filling the unique societal niche of both a comforter to mourning families and also witnesses to the impacts of adverse drug events. These drug events are not limited to the deceased: there have been noted incidents of drug use concurring in the funeral home by the mourning family and friends. With this context, the NDEWS team will be interviewing funeral directors for their unique perspective on drug-related mortality during the COVID-19 pandemic.

The National Drug Early Warning System (NDEWS) is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (PI: Cottler; Co-Is: Goldberger, Nixon, Striley), New York University (Co-I: Palamar), and Florida Atlantic University (Co-I: Barenholtz).