Lethality, availability and use of stimulants have greatly increased in the US. The CDC has reported that overdose deaths more than tripled for cocaine and increased nearly five-fold for methamphetamine since 2012. USA Today reports that “people addicted to opiates hear others talk about a new high, cheap and easy to get and safer than fentanyl. Meth is that alternative.” With more than 100 deaths every day in this country attributed to opioid overdose, there is understandable – and much appreciated – attention to this issue. A significant increase in overdose death rates from synthetic opioids such as fentanyl and its analogues make it very clear that we must continue to address the threat from the opioids in this country. 
These two major drug problems, and our field, are now impacted by an unprecedented 3rd threat in this country, that of the Covid-19 pandemic. At the time of this writing, more than 8 million Americans have tested positive for Covid-19 and over 220,000 people have died of this disease. Individuals struggling with substance use disorder (SUD) or those in recovery may find COVID-19 and the non-medical impacts of COVID-19 more difficult than the general population. There has been an increase in substance use for those with a period of remission and social isolation has led to increases in depression, anxiety, domestic violence, and other mental health disorders. With this “triple threat” of opioids, stimulants, and Covid-19, we need to rethink how we assess, support and deliver treatment to those with SUD.