Disruptions to U.S. local public health’s role in population-based substance use prevention and response during COVID-19

Background

The COVID-19 emergency has tested the public health, medical, and public safety infrastructure of the United States (U.S.) in unprecedented ways. As the focal point for public health in their communities, local health departments (LHDs) were particularly impacted by the pandemic’s onset. The pandemic limited the scale and scope of local health department (LHD) work, redirecting resources to the response. However, the need for essential public health services—including substance use prevention—was not reduced.

Methods

Six quantitative data sources were examined, collected between 2016 and 2021, to explore the impact of the COVID-19 pandemic on LHD substance use-related services. For each of these surveys, the unit of analysis is organisation, so each LHD provided one response to the survey. These data collection efforts were part of existing longitudinal studies beginning prior to the onset of the COVID-19 pandemic and spanning the first year of the pandemic.

Results

Before the pandemic, the proportion of LHDs providing some level of substance use prevention services was increasing, and many were expanding their level of provision. During the pandemic, 65% of LHDs reduced their level of substance use-related service provision, but the proportion of LHDs providing some level of services remained steady from prior to COVID-19.

Conclusion

LHDs were making great advancements in the substance use space—and specifically, with the opioid overdose epidemic—pre-pandemic, but those advancements were stymied with the onset of COVID-19. Given the findings, it is important for federal agencies and national organisations to support LHDs in returning to pre-pandemic levels of substance use service provision through direct funding and technical assistance. Given the disproportionate negative impacts of service disruptions on marginalised populations, it is imperative that local public health works to ensure this availability of substance use treatment and resources for all those in need. With this in mind, support should focus on the circumstances of service provision in a post-pandemic world, especially as it relates to supporting tele-health for vulnerable and underserved populations. In addition, LHDs are not working in a vacuum to address substance use, so support should focus on cultivating effective multi-sector partnerships or coalitions.