The COVID-19 vaccine won’t solve major substance use disorder treatment gaps

When COVID-19 vaccines finally arrived, a lot of us quietly hoped they’d be a reset button: fewer hospitalizations, less fear, and maybejust maybea break for people living with substance use disorders (SUDs) who were hit especially hard during the pandemic. The vaccines have absolutely saved lives and reduced severe illness. But here’s the tough truth: no shot in the arm can fix decades of underfunded, patchwork addiction treatment in the United States.

Even as booster campaigns roll on and pandemic restrictions fade, the United States is still in a deep substance use and overdose crisis. Tens of millions of people meet criteria for a substance use disorder every year, but only a small fraction ever receive treatment. In recent estimates, about 87% of Americans with an SUD are not getting the help they need. That gap isn’t caused by a virus, and it won’t disappear just because we have vaccines for one.

So let’s talk about why the COVID-19 vaccineessential as it iscan’t solve major substance use disorder treatment gaps, what actually drives those gaps, and what it would take to close them for real.

The overdose crisis didn’t start with COVIDand it didn’t end with vaccines

Long before anyone had heard the word “coronavirus,” overdose deaths were climbing steadily. CDC data show that drug overdose death rates soared from 2003 through the 2010s, with especially sharp increases driven by opioids like heroin and fentanyl. The pandemic poured fuel on that fire: isolation, stress, disrupted services, and an increasingly toxic drug supply led to record-breaking overdose deaths in 2020 and 2021.

In 2021, more than 46 million Americans aged 12 and older had a substance use disorderaround 16.5% of the populationyet only about 6% received any treatment. By 2023, overdose deaths finally dipped modestly, but more than 100,000 people still died. Recent data from 2024 show a larger 24–27% drop in overdose deaths, which is encouraging, but the total number of deaths is still far above pre-pandemic levels.

In other words, vaccines helped turn down one emergency (severe COVID-19) while another emergencyaddiction and overdosekept burning in the background. That’s because SUD treatment gaps are rooted in structural, financial, and social problems that a biomedical tool like a vaccine simply cannot touch.

What the COVID-19 vaccine can (and can’t) do for people with SUD

First, the good news. COVID-19 vaccines work. They dramatically reduce the risk of severe illness, hospitalization, and death, including for people living with SUD, who often have higher rates of chronic conditions and are more vulnerable to infections. Getting vaccinated remains one of the best ways to protect your health if you use substances, are in recovery, or live in a community heavily affected by overdose.

But people with SUD and serious mental illness often face barriers even to vaccination itself: transportation issues, unstable housing, lack of trust in healthcare systems, misinformation, and competing priorities like finding a safe place to sleep or managing withdrawal. Studies have found that individuals with SUD and major mental illness often have lower vaccination uptake than the general population and face unique access challenges.

And even when vaccination barriers are addressed, a shot that protects against a virus can’t:

• Make addiction treatment affordable or nearby.
• Expand the workforce of counselors, physicians, and peer specialists.
• Guarantee access to evidence-based medications like buprenorphine or methadone.
• Undo stigma from healthcare providers, employers, or families.
• Repair the social and economic damage caused by years of untreated substance use.

That’s not a failure of the vaccineit’s a reminder that public health crises are rarely solved by a single intervention, especially when the root causes are social and structural.

The scale of the substance use treatment gap

To understand why vaccines can’t fix this, you have to see just how big the treatment gap really is.

Recent analyses of national survey data found that roughly 87% of Americans with an SUD are not receiving treatment in any given year. Among adults with opioid use disorder (OUD), the situation is especially stark: in 2022, about 3.7% of U.S. adults needed OUD treatment, but only 25.1% received medications for opioid use disorder (MOUD) such as methadone, buprenorphine, or naltrexone.

Even more worrying, the majority of people who needed OUD treatment either didn’t receive any treatment at all or received care without medications, even though medications are the gold standard and significantly reduce overdose deaths and improve long-term outcomes.

In other words, the problem isn’t just that people aren’t getting any helpit’s that they’re often not getting the right kind of help.

Why treatment gaps persist: it’s not about motivation

A common myth is that people don’t get addiction treatment because they “don’t really want it.” Reality is much more complicated. Research shows that while some people don’t perceive a need for treatment, many face powerful barriers that would challenge anyone.

1. Cost, insurance, and coverage limits

Addiction treatment can be expensive, and insurance coverage is often confusing, limited, or missing altogether. Surveys highlight financial barriers as one of the biggest reasons people never make it into care: high deductibles, lack of insurance, job loss, or losing Medicaid can all slam the door on treatment.

Even when people do have coverage, they may run into strict prior authorizations, limits on the number of counseling sessions, or refusals to cover certain medications. For someone trying to stay alive and stable, “your insurance denied it” is not just an inconvenienceit can be deadly.

2. Workforce shortages and burnout

You can’t expand treatment if there aren’t enough people to provide it. States across the country report a serious substance use treatment workforce crisis: not enough addiction psychiatrists, counselors, social workers, or peer recovery coaches, especially in rural and underserved communities.

Providers who are working in the field often juggle heavy caseloads, low pay, administrative burdens, and emotional burnout. That turnover makes it harder for patients to build trusting, long-term relationships with their care teams.

3. Stigmafrom society and from the system

Stigma is not just about mean comments or dirty looks. It’s baked into policies, clinic rules, and sometimes provider attitudes. Studies of care management and treatment staff have documented how structural and interpersonal stigmalike assuming patients are “noncompliant” or “manipulative”creates real barriers to care, from rigid program rules to outright denial of services.

For patients, this can mean feeling judged, dismissed, or punished for seeking help. Imagine being expected to show up perfectly on time, drug-free, with stable transportation and childcare, before anyone will help you with… your drug use. Not exactly a recipe for success.

4. Limited access to evidence-based medications

Medications for opioid use disorder are among the most rigorously studied tools in addiction medicine. Methadone and buprenorphine can cut the risk of overdose death dramaticallyas much as 80% in the first month after release from jail, when people are at very high risk.

Despite this, MOUD remains underused and hard to access. Many communities lack clinics authorized to prescribe or dispense these medications, and some courts, jails, and treatment programs still restrict or discourage their use. Without widespread access to these medications, it’s impossible to close the treatment gap meaningfully.

5. Fragmented care and limited integration with primary care

Substance use care is often siloed away from the rest of healthcareas if addiction lives in a separate universe from diabetes, heart disease, or depression. But that’s not how real life works. People with SUD usually have other health conditions that bring them into primary care and emergency departments long before they see an addiction specialist.

Research shows that integrating SUD treatment into primary carethrough screening, brief interventions, onsite medications, and collaborative care modelscan identify more people earlier and improve outcomes. Yet many primary care clinics still lack training, time, or infrastructure to make this happen consistently.

How the pandemic changed addiction treatment (and what stuck)

If there’s one area where the pandemic forced rapid innovation, it’s telehealth. Before COVID-19, fewer than 1% of SUD treatment centers used telemedicine. Then lockdowns hit, regulations loosened, and suddenly therapy sessions, group counseling, and even MOUD visits moved online.

Studies since then have shown that telehealth-based SUD treatment can be feasible, effective, and popular with patients. Virtual intensive outpatient programs have helped people stay engaged while juggling work, childcare, or transportation challenges. Research also suggests that providers who use telehealth more heavily may have lower SUD-related hospitalization rates among their patients.

That’s the good news. The not-so-good news: telehealth alone can’t fix an underfunded system. Many of the people at highest risk of overdose also face housing instability, limited internet or phone access, and difficulty maintaining privacy for virtual visits. And as pandemic-era policy flexibilities expire or shift, there’s a risk that some of the hard-won gains in access could be rolled back.

So what would close the treatment gap?

If COVID-19 vaccines aren’t the magic solution, what is? There’s no single silver bulletbut there are several evidence-informed strategies that, combined, could dramatically shrink the gap between people who need care and people who get it.

1. Make treatment affordable and easy to use

Policies that expand Medicaid, reduce insurance barriers, and enforce parity laws (which require mental health and SUD care to be covered comparably to physical health care) can bring treatment within reach for millions. reversing cuts that reduce coverage for low-income adults is essential; otherwise, people lose access to OUD treatment and overdose deaths rise.

On the ground, this looks like sliding-scale fees, same-day intakes, walk-in clinics, and mobile outreach that brings care to people instead of waiting for them to navigate a maze of referrals.

2. Invest in the addiction treatment workforce

Closing the gap means training and supporting more clinicians in addiction carephysicians, nurse practitioners, physician assistants, psychologists, social workers, peer specialists, and community health workers. National groups have called for higher pay, better training, and long-term funding to stabilize this workforce and reduce burnout.

Residency programs and medical schools are starting to weave addiction medicine into core training, but scaling that up nationwide will take sustained effort and investment.

3. Normalize medications and harm reduction

Expanding access to MOUD, syringe service programs, naloxone distribution, and drug-checking services saves liveseven for people who aren’t ready or able to stop using substances entirely. These approaches treat overdose as a preventable health outcome, not a moral failure.

As more communities embrace harm reduction and MOUD as standard care, we can move from reacting to overdoses to preventing them.

4. Integrate SUD care into everyday healthcare

Imagine if screening for alcohol or opioid use was as routine as checking blood pressure. Integrating SUD care into primary care, emergency departments, and community clinics helps catch problems earlier and reduces the stigma of walking into a standalone “rehab” facility.

Mobile health tools, text-based supports, and app-based recovery programs can extend this care between visitsespecially when they’re connected to real human providers, not just a lonely notification reminding you to “log your cravings.”

5. Fight stigma with language, policy, and practice

Language matters. Replacing terms like “addict” or “clean/dirty” with “person with a substance use disorder” or “positive/negative test” is not “political correctness”it’s evidence-based stigma reduction that improves willingness to seek care and improves provider attitudes.

At the policy level, treating SUD as a chronic health condition instead of a criminal issuethrough diversion programs, treatment in jails and prisons, and re-entry supports with MOUDcan dramatically reduce overdose risk after incarceration.

Vaccines are vitalbut they’re not a treatment plan

The COVID-19 vaccine is a public health success story. It protects peopleincluding those with SUDfrom severe illness and death due to a dangerous virus. It keeps hospitals from being overwhelmed and helps communities function more safely.

But when it comes to substance use disorder treatment gaps, vaccines are more like a side quest than the main mission. They may make it safer for people to seek care in person and reduce the burden on stressed health systems, but they don’t change the fundamental math: millions of people with SUD, a small fraction getting effective care, and a system that still makes treatment feel like a luxury instead of a basic right.

If we want to truly “get back to normal,” we have to admit that the old normal wasn’t working for people with addiction. Closing treatment gaps will require policy changes, funding, workforce investment, stigma reduction, and a commitment to evidence-based care that lasts far longer than any news cycleor any vaccine rollout.

Real-world experiences from the treatment gap

Statistics are important, but the treatment gap is maybe easiest to understand through real-world experiences. The following stories are composites based on common patterns described in research and clinical practicenot any single person’s experiencebut they capture what the system often feels like from the inside.

Maria: Covered for COVID, not covered for care

Maria is 42, works two part-time jobs, and takes care of her mom. During the height of the pandemic, she got her COVID-19 vaccine at a pop-up clinic in her neighborhood. It was fast, free, and came with a sticker that said “I did my part.”

But when Maria finally decided she was ready to get help for her opioid useafter a frightening overdose at homethe process could not have been more different. The nearest clinic that prescribed buprenorphine had a three-week wait list. Her insurance covered some of the visits but not the medication she was initially prescribed. The co-pays for therapy added up quickly. When her work schedule changed, she started missing appointments and eventually got discharged from the program.

Maria did “her part” for COVID. The system didn’t fully do its part for her substance use disorder.

Jamal: Telehealth helpsuntil the phone is gone

Jamal, 29, started using telehealth counseling during the pandemic. For the first time, he could talk to a therapist without taking two buses across town or explaining to his boss why he needed another afternoon off. He made progress: fewer days of use, more steady work, and a slowly rebuilding relationship with his sister.

Then his phone service was cut off when he fell behind on payments. Without a stable address, he couldn’t easily receive mail or reminders from his clinic. His next appointment came and went. By the time he managed to reconnect with his provider, he’d relapsed and ended up in the emergency department after an overdose.

Telehealth made treatment more flexible for Jamalbut only as long as the basic building blocks of daily life (a phone, data, a quiet place to talk) stayed in place. When they didn’t, the old risks came roaring back.

Sara: Leaving jail, losing protection

Sara, 36, spent six months in jail during the pandemic. While inside, she never received medications for her opioid use disorder, despite years of struggling and a history of overdose. She did, however, get a COVID-19 vaccine when it became available to incarcerated people.

Two weeks after release, she overdosed. This pattern is heartbreakingly common: people leaving jail or prison face a dramatically higher risk of fatal overdose, particularly if they haven’t had access to MOUD during incarceration and lose tolerance to opioids. A vaccine protected Sara from a virusbut she left custody with no protection against the chronic condition that posed the greatest threat to her life.

Luis: A primary care visit that changed everything

Luis, 51, went to his primary care clinic for his blood pressure and diabetes. During the visit, his doctor asked him some routine screening questions about alcohol and drug use. Luis hesitated but eventually admitted he’d been drinking much more heavily since the pandemic, and it was starting to affect his job and sleep.

Instead of a lecture, the doctor responded with empathy and information. The clinic had an integrated behavioral health team, including a counselor trained in addiction and a peer recovery coach. Luis started brief counseling right there and scheduled a follow-up telehealth visit a week later. Over the next few months, he cut back significantly, improved his sleep, and felt more in control.

Luis still got his COVID-19 booster every fall. But the real game-changer was a healthcare system that treated his alcohol use as part of his overall health, not as an embarrassing side note.

These stories highlight a crucial point: vaccines can protect people from COVID-19, but only a robust, compassionate, and well-funded addiction treatment system can protect them from the ongoing risks of substance use disorders. Closing the gap requires us to build that system on purposeso that when someone is ready for help, the door is actually open.