Due to changes in economic stressors, housing insecurity, and social support access, the COVID-19 pandemic has potentially created a disproportionate burden on individuals who use substances. In Massachusetts, Weiner et al. quantified this burden with a retrospective cross-sectional study examining the changes in substance-related 9-1-1 calls from February to May 2020. Comparing early March to February 2020, substance-related daily ambulance calls decreased by 16.4% while total daily ambulance calls decreased by 19.7%. However, after the stay-at-home advisory by the end of March, substance-related calls increased back to pre-pandemic levels while all other 9-1-1 calls remained at the decreased, pandemic-related level. Possibly due to concerns of COVID-19 infection from the hospital, there was also a change from 5% to 7.5% for individuals refusing ambulance transport for substance-related issues. Recommendations include use of the Massachusetts program “Leave-Behind-Naloxone” in which emergency medical providers leave overdose medication and education with patients refusing ambulance transport. Virtual access to treatment and support groups is also recommended.