What is the impact of COVID-19 pandemic upon therapeutics of opioids crisis and the strategy to mitigate these effects?

The opioid crisis in America resulted in >70,000 deaths in 2017, however improvement has been made, with significant reduction in opioid related deaths being seen over the past 2-3 years (1). Urine drug testing (UDT) remains an effective tool in pain management to monitor compliance with prescribed medications. National guidelines as put forth by the American Society of Interventional Pain Physicians and the American Association for Clinical Chemistry Academy recommend UDT not only to assess compliance but also to detect undisclosed substances and diversion (2). Clinical laboratories provide a necessary service and should be equipped to offer an extensive UDT test menu to aid in the management of patient compliance and the mitigation of the current opioid crisis.

How could the COVID-19 crisis impact chronic pain patients and the opioid crisis?

As we are now well aware, the COVID-19 global pandemic is an ongoing challenge that has many effects across the medical spectrum. These include a decrease in face-to-face appointments and an increase in telehealth visits. Unfortunately, the pandemic has also resulted in a period of necessary isolation, to reduce the spread of the virus and to maintain sufficient capacity in hospitals. This increase in isolation may be leading to an increase of despair in patients suffering from substance use disorders (3). 

What are the current concerns regarding the collision of these two crises?

In an Issue brief, the American Medical Association expressed significant concern regarding increasing reports from national, state, and local media suggesting increases in opioid-related mortality—particularly from illicitly manufactured fentanyl and fentanyl analogs (4). More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder (4).

When COVID-19 struck, the U.S. was already in the grip of the drug-overdose crisis, and unfortunately it has gotten worse during these unprecedented times. Counties in states spanning the country, from Washington to Arizona and Florida, are reporting rising drug fatalities this year, according to data collected by The Wall Street Journal (5). This follows a likely record number of deadly overdoses in the U.S. last year, with more than 72,000 people killed, according to federal projections (5).

What can be done to mitigate these concerns?

In the May 13, 2020 report from the overdose detection mapping application program (ODMAP), suggestions for intervening during this sensitive time included increasing evidence-based harm reduction services – such as needle exchanges, and increased access to naloxone (3). Clinicians and laboratory professionals should be aware of the language they are, with emphasis on therapeutic effect, and reduction of punitive language. The management of opioid misuse disorders requires strong bridging between clinicians and laboratory professionals, and this is only amplified during the pandemic.

Resources

1. Wilson N, Kariisa M, Seth P, Smith H IV, Davis NL. Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018. MMWR Morb Mortal Wkly Rep 2020; 69:290–297. DOI: http://dx.doi.org/10.15585/mmwr.mm6911a4external icon
2. Petrides et al. Urine Drug Testing: Debates Over Best Practices to Assess Compliance and Manage the Opioid Crisis, Clinical Laboratory News. Jan 1, 2019.
3. Alter and Yeager. The consequences of covid-19 on the overdose epidemic: Overdoses are Increasing, Overdose detection mapping application program. May 13, 2020
4. American Medical Association. 2020 October 21. Issue brief: Reports of increases in opioid-related overdose and other concerns during COVID pandemic. Accessed online Nov 6,2020
5. Kamp and Campo-Flores. The Opioid Crisis, already serious, has intensified during Coronavirus Pandemic, The Wall Street Journal. 2020 September 8.