OBJECTIVES: Diseases of despair (DOD; overdoses, alcohol related disorders, drug use disorders and suicide) are rising in the US and are exacerbated by social isolation and unemployment. States varied the level of social restrictions in response to the COVID-19 pandemic providing a natural experiment to assess the impact of these policies on development of DOD.

METHODS: Using US commercial claims, we employed a multi-group interrupted time series analysis to examine the rates of DOD between states that had high levels of COVID-19 related social restrictions compared to states with fewer. Subjects included enrollees eligible for medical benefits for at least one month between June 2017 through October 2021. Using the PEW criteria, states were classified into three groups (most, less, and least restrictive) based on COVID-19 policy restrictiveness. Monthly rates of the number of persons with one or more DOD diagnoses and DOD-related healthcare encounters were calculated. March 2020 was the interruption time point and pair-wise comparisons were made between the three restrictiveness groups.

RESULTS: A total of 4,316,563 eligible enrollees were included: least-restrictive (n=1,533,628), less-restrictive (n=2,347,033), and most-restrictive (n=435,902). The mean monthly rates of individuals with one or more DOD diagnoses per 100,000 eligible enrollees over the entire series were: least-restrictive=365.70, less-restrictive=359.53, most-restrictive=297.71. No significant differences were detected in the level or slope changes for most-restrictive states relative to least-restrictive states on composite measures of DOD and nearly all individual DOD (p>0.05) examined except the rate of individuals (slope difference=1.47; 95%CI:0.40-2.53) and encounters (slope difference=3.19, 95%CI:1.03-5.34) with opioid use disorders recorded.

CONCLUSIONS: Except for a slight increase in opioid use disorder diagnosis rates following COVID-19, imposing more pandemic related restrictions, such as stay at home orders and closure of non-essential businesses, do not appear to affect rates at which persons seek care for diseases of despair in the near term.