Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Robert Heimer

Second Advisor

Paul Joudrey


The onset of the COVID-19 pandemic in March 2020, complicated the already ineffectual delivery of health care for historically hard-to-reach populations. Those who face housing insecurity, substance use disorders, unemployment, or uncertain immigration and insurance status were abandoned, as the mainstream U.S healthcare system struggled to cope under the pressure of the novel virus. While parallel public health crises were put on hold to deal with COVID-19, the pandemic collided with and exacerbated the ongoing opioid crisis. Using New London, CT as a case study, this project set out to address a gap in literature on the potential syndemic effect of COVID-19 and the opioid crisis on people living with substance use disorders (SUDs). Data were collected through a self-administered survey among patients of an urban harm reduction service in New London, CT over a 12-month period. The survey collected demographic data as well as questions on COVID-19 knowledge, COVID-19 risk behaviors, and COVID-19 attitudes and perceptions. Using descriptive statistics and multivariate linear regression models, this study found that there was low COVID-19 knowledge in the sample population, particularly among ethnic/racial minorities or people experiencing unemployment. Additionally, a high proportion of the respondents relied on the ER to meet their healthcare needs, struggled to access testing, and felt quarantine would present difficulties. The population also exhibited a high level of vaccine hesitancy, and their COVID-19 risk behavior increased over time (particularly among racial/ethnic minorities, and people experiencing unemployment). Finally, the survey respondents grew increasingly confused over the COVID-19 messaging they were receiving over time. The results of this study suggest that the opioid crisis and COVID-19 are acting synergistically to increase disease burden for people living with SUDs, particularly those experiencing double marginalization due to their racial/ethnic identity or socioeconomic background. The findings, also underscore the need for further research at the intersection of COVID-19 and SUDs, and carry significant public health implications in terms of COVID-19 information dissemination, COVID-19 vaccine campaigns, and access to basic healthcare for people who use drugs.


This is an Open Access Thesis.

Open Access

This Article is Open Access