The Opioid Epidemic During the COVID-19 Pandemic

Haley, Danielle F.; Saitz, Richard

doi:10.1001/jama.2020.18543

Cited by 159 publications

(122 citation statements)

References 15 publications

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“…1 Deaths due to opioid overdoses have also increased, which may be associated with reductions in access to care. 2,3 Disruptions in care may have affected new and existing patients differently. Patients taking prescription opioids may have experienced supply reductions, with possible negative outcomes regarding pain control and switching to nonprescription opioids (illegal drugs such as heroin and illicit fentanyl).…”

Section: Introductionmentioning

confidence: 99%

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2021

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IMPORTANCEThe COVID-19 pandemic disrupted medical care, impacting prescribing of opioid analgesics and buprenorphine for opioid use disorder. Understanding these patterns can help address barriers to care. OBJECTIVE To evaluate how prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic among both new and existing patients. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, use of opioid analgesics and buprenorphine for opioid use disorder from March 18 to September 1, 2020, was projected using a national database of retail prescriptions from January 1, 2018, to March 3, 2020. Actual prescribing was compared with projected levels for all, existing, and new patients. EXPOSURESThe data include prescriptions to patients independent of insurance status or type and cover 90% of retail prescriptions, 70% of mail-order prescriptions, and 70% of nursing home prescriptions. MAIN OUTCOMES AND MEASURESPrescriptions for opioid analgesics and buprenorphine for opioid use disorder. Outcomes included total number of prescriptions, total morphine milligram equivalents, mean morphine milligram equivalents per prescription, mean dispensed units per prescription, and number of patients filling prescriptions. RESULTSA total of 452 691 261 prescriptions for opioid analgesics and buprenorphine for opioid use disorder were analyzed for 90 420 353 patients (50 921 535 female patients [56%]; mean [SD] age, 49 [20] years). From March 18 to May 19, 2020, 1877 million total morphine milligram equivalents of opioid analgesics were prescribed weekly vs 1843 million projected, a ratio of 102% (95% prediction interval [PI], 94%-111%; P = .71). The weekly number of opioid-naive patients receiving opioids was 370 051 vs 564 929 projected, or 66% of projected (95% PI, 63%-68%; P < .001). Prescribing of buprenorphine was as projected for existing patients, while the number of new patients receiving buprenorphine weekly was 9865 vs 12 008 projected, or 82% (95% PI, 76%-88%; P < .001). From May 20 to September 1, 2020, opioid prescribing for new patients returned to 100% of projected (95% PI, 96%-104%; P = .95), while the number of new patients receiving buprenorphine weekly was 10 436 vs 11 613 projected, or 90% (95% PI, 83%-97%; P = .009). CONCLUSIONS AND RELEVANCEIn this cross-sectional study, existing patients receiving opioid analgesics and buprenorphine for opioid use disorder generally maintained access to these medications during the COVID-19 pandemic. Opioid prescriptions for opioid-naive patients decreased briefly and then rebounded, while initiation of buprenorphine remained at a low rate (continued) Key Points Question How has prescribing of opioid analgesics and buprenorphine for opioid use disorder changed throughout the COVID-19 pandemic? Findings This cross-sectional study analyzed prescriptions from 90 420 353 patients and found that from March 18 to May 19, 2020, total morphine milligram equivalents of opioid analgesics prescribed to existing patients followed ...

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Section: Introductionmentioning

confidence: 99%

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2021

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“…FEN is believed to specifically account for nearly 30,000 of the 50,000 deaths involving opioids annually, due to its high potency, ease of manufacturing, and/or addition to other illicit drugs unknowing to the user [3][4][5] . Since the 2020 COVID-19 pandemic, there is new evidence that FEN use and opioid overdoses may also be increasing 6 . FEN and FEN-analogs rapidly penetrate the central nervous system and are 50-100 times more potent than heroin and morphine respectively.…”

Section: Introductionmentioning

confidence: 99%

Fentanyl conjugate vaccine by injected or mucosal delivery with dmLT or LTA1 adjuvants implicates IgA in protection from drug challenge

et al. 2021

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Fentanyl is a major contributor to the devastating increase in overdose deaths from substance use disorders (SUD). A vaccine targeting fentanyl could be a powerful immunotherapeutic. Here, we evaluated adjuvant and delivery strategies for conjugate antigen vaccination with fentanyl-based haptens. We tested adjuvants derived from the heat-labile toxin of E. coli including dmLT and LTA1 by intramuscular, sublingual or intranasal delivery. Our results show anti-fentanyl serum antibodies and antibody secreting cells in the bone-marrow after vaccination with highest levels observed with an adjuvant (alum, dmLT, or LTA1). Vaccine adjuvanted with LTA1 or dmLT elicited the highest levels of anti-fentanyl antibodies, whereas alum achieved highest levels against the carrier protein. Vaccination with sublingual dmLT or intranasal LTA1 provided the most robust blockade of fentanyl-induced analgesia and CNS penetration correlating strongly to anti-FEN IgA. In conclusion, this study demonstrates dmLT or LTA1 adjuvant as well as mucosal delivery may be attractive strategies for improving the efficacy of vaccines against SUD.

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“…7 It is widely reported in local and national media that overdose deaths have increased since the beginning of the pandemic, but these reports have not been confirmed due to the absence of nationwide real-time overdose death reporting. 8,9 What can we do as addiction healthcare providers to help lessen the disastrous impact of COVID-19? First, we can provide psychological first aid which means fostering safety, self-care, calming skills, social connectedness, and hope in the individuals we treat.…”

Section: Editorialmentioning

confidence: 99%

President’s message: The COVID-19 pandemic through the lens of disaster psychiatry

Kmiec¹

2020

Journal of Addictive Diseases

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The Opioid Epidemic During the COVID-19 Pandemic

Abstract: You SC, Rho Y, Bikdeli B, et al. Association of ticagrelor vs clopidogrel with net adverse clinical events in patients with acute coronary syndrome undergoing percutaneous coronary intervention. JAMA.

Cited by 159 publications

References 15 publications

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

Prescribing of Opioid Analgesics and Buprenorphine for Opioid Use Disorder During the COVID-19 Pandemic

Fentanyl conjugate vaccine by injected or mucosal delivery with dmLT or LTA1 adjuvants implicates IgA in protection from drug challenge

President’s message: The COVID-19 pandemic through the lens of disaster psychiatry

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