When the pandemic hit, visits to hospital emergency departments plummeted by more than 40%. People were scared of catching the coronavirus.
But Kristin Holland, a researcher at the Centers for Disease Control and Prevention, found patients experiencing drug-related crises needed help so desperately they kept coming.
"All overdoses and opioid overdoses...those were the only two [categories] for which we saw an increase," Holland said.
Holland's peer-reviewed study published in the Journal of the American Medical Association analyzed roughly 190 million emergency department visits, comparing cases in 2020 with activity the year before.
The data showed people who didn't catch the coronavirus were still hit hard by disruptions caused by the pandemic. They turned up at emergency departments needing a different kind of care.
"People are indeed experiencing poor mental health, suicidal thoughts, and substance use potentially as a coping mechanism," Holland said.
But experts say many emergency departments aren't well staffed or trained to help patients with these kinds of problems.
"Emergency physicians have always been able to treat the overdose, but we did not have the tools to treat the addiction or the dependency," said Dr. Mark Rosenberg, president of the American College of Emergency Physicians.
ACEP has worked for years to help emergency departments improve addiction care, but Rosenberg says reform has come slowly.
He points to the fact that most emergency doctors still don't use buprenorphine, a drug proven to people with opioid addiction avoid relapse.
"Only one-third of patients get medications for opioid use disorder in the emergency department," Rosenberg said.
"What we know is that those patients discharged from the hospital without any further treatment who are an overdose are a hundred times more likely to die within the year."
Rosenberg and others said regulatory hurdles and stigma around people with drug use disorders have kept many emergency departments from improving their addiction care.
"I think there was a lot of hesitancy because it's not what we've done, it's not what I trained in," said Dr. Stephen Viel, head of the emergency team at Halifax Medical Center in Daytona Beach, Fla.
After a spate of overdose deaths three years ago, Viel changed his department, adopting the use of buprenorphine and adding an addiction counselor to his emergency team.
That counselor, Larry Brooks, is himself in recovery from substance use disorder. He said beginning addiction care in the emergency department immediately after overdose patients are revived can prevent future relapses and deaths.
"This is the best time for us as a health organization and a community as a whole to make an impact and say, look, somebody is here," Brooks said.
"You're not going to get kicked right back out the door and go into withdrawal and have to find [more drugs] and then be back here in two hours."
But emergency department addiction programs like the one at Halifax Medical are still rare. CDC researcher Kristin Holland said she hopes data from her study will convince more hospitals to change.
"If people are coming to the emergency department for these outcomes, that's where we need to meet them," she said.
While deaths from COVID-19 have dropped from their peak, the CDC says fatal overdoses nationwide keep rising, with more than 220 drug deaths every day.