On April 28, 2021, the U.S. Senate Committee on Health, Education, Labor and Pensions heard testimony from four mental health experts concerning the nation’s mental health and substance use disorder crisis in relation to the ongoing COVID-19 pandemic, in an effort to learn how best to address the escalating unmet mental health needs of millions of Americans. Following are the evidence and recommendations of the second witness, based on lessons learned this past year. 

The witness

Sara Goldsby is the Director of the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS), which plays a critical role in overseeing and implementing the publicly funded prevention, treatment, and recovery service system. DAODAS accomplishes this in several ways, by:

• Requiring each county’s alcohol and drug abuse authority to submit an annual strategic plan to address alcohol and other drug issues 
• Supporting the State Epidemiological Outcomes Workgroup (SEOW), whose annual reports on prevalence and burden of substance use in South Carolina informs priorities for planning and are shared with statewide stakeholders
• Co-leading the state’s Opioid Emergency Response Team that develops and manages the emergency plan to address the opioid epidemic 

The scope of the crisis

As is the case for many other Americans, the COVID-19 pandemic has resulted in many South Carolinians experiencing significant psychological distress linked to anxiety, fear, stress, isolation, and economic loss. These factors exacerbated the state’s existing substance use issues during 2020. The volume of calls to DAODAS’s main telephone line (the point of connection from SAMHSA’s National Helpline) increased 25%-35% from April through June 2020. Most callers seeking services for family members or friends in need of treatment for a substance use disorder.

Alcohol sales were 27% higher between March 15 and June 30, 2020 than during the same timeframe in 2019. Suspected opioid overdoses with EMS response were already slightly higher at the start of 2020 than at the start of 2019, but that gap widened dramatically in March, and May 2020 yielded the highest numbers in the state’s history. Suspected opioid overdoses reported by South Carolina EMS were around 40%-50% higher in 2020 than in 2019. Overdose incidents continue to remain elevated in 2021.

The CDC estimated 1,625 drug overdose deaths in South Carolina for the 12-month period ending in September 2020, a 45.3% increase over the prior 12-month period. Approximately 62.4% of those deaths involved illegally-made synthetic opioids. 

During the pandemic, the agency’s public safety partners also noted:

• An increased number of seizures of illicit drugs being delivered by the U.S. Postal Service and parcel services
• New illegal benzodiazepines being produced and trafficked in larger volumes 
• An increase in non-opioid prescription drugs, such as ketamine and gabapentinoids, in patient drug screens, and in toxicology reports from overdose fatalities. 

Recommendations from the expert

Based on what she’s learned from the challenges of the past year, Dr. Goldsby recommends that the federal government: 

• Route federal funds for substance use disorder services Through the State Alcohol and Drug Agency
• Maintain pandemic-related regulatory flexibilities to ensure access to substance use disorder services. These flexibilities include, among others:
  • Take-home doses of methadone for certain patients
  • The ability to initiate buprenorphine treatment for opioid use disorders without a face-to- face appointment
  • Reasonable flexibilities related to HIPAA rules in order to allow providers more options for service delivery
• Invest in technology and broadband to make telehealth substance use disorder services more accessible
• Continue support for workforce development, including the prevention workforce proposal in The Comprehensive Addiction and Recovery Act (CARA) 3.0, particularly section 211
• Bolster the Role of the Substance Abuse and Mental Health Services Administration (SAMHSA) 
• Maintain a Strong White House Office of National Drug Control Policy (ONDCP)

*U.S. Senate Committee on Health, Education, Labor and Pensions. (2021, Apr. 28). Examining Our COVID-19 Response: Using Lessons Learned to Address Mental Health and Substance Use Disorders [Video of Full Committee Hearing]. https://www.help.senate.gov/hearings/examining-our-covid-19-response-using-lessons-learned-to-address-mental-health-and-substance-use-disorders 

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