The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020

Abstract

The convergence of the opioid epidemic and the coronavirus disease 2019 (COVID-19) pandemic has created new health care challenges. The authors analyzed changes in clinical drug testing patterns and results at a national clinical laboratory, comparing data obtained before and during the pandemic. Testing for prescription and illicit drugs declined rapidly during the pandemic, with weekly test volumes falling by approximately 70% from the baseline period to the trough (the week beginning March 29) before rising in subsequent weeks. Among individuals tested, positivity increased by 35% for non-prescribed fentanyl and 44% for heroin during the pandemic. Positivity for non-prescribed fentanyl increased significantly among patients positive for other drugs: by 89% for specimens positive for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < 0.01 for all comparisons). These findings suggest significant increases in dangerous drug combinations. Positivity for non-prescribed use of many other drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. Models adjusting for potential confounding variables, including medication-assisted treatment and treatment at a substance use disorder facility indicated that the risk for non-prescribed fentanyl positivity rose by more than 50% during the pandemic. In summary, these findings demonstrate decreased drug testing overall, with increased positivity for high-risk drugs and dangerous drug combinations. The convergence of the drug abuse epidemic and COVID-19 pandemic has led to an increased need for health care and public health resources dedicated to supporting vulnerable patients and addressing the underlying causes of these disturbing trends.

Population-scale patient safety data reveal inequalities in adverse events before and during COVID-19 pandemic

“…In both networks, cardiac and respiratory arrest are associated with a similar cluster of nervous system-related drugs, including common Benzodiazapines and Opioids such as Fentanyl, Oxycodone, Methadone, and Diamorphine. Many of these drugs are known to be highly addictive and sheds light on how the COVID-19 pandemic has impacted the ongoing substance abuse epidemic [45, 46]. Moreover, Methadone is only enriched in women, while Diamorphine is only enriched in men, suggesting a potential gender difference in the use of addictive substances.…”

Reducing COVID-19 opioid deaths

“…10 A similar drug testing study found that during the pandemic, the proportion of positive results (positivity) increased by 35% for non-prescribed fentanyl and 44% for heroin. 11 Positivity for non-prescribed fentanyl increased significantly among patients who tested positive for other drugs, including by 89% for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < .01 for all). 11 In a review of electronic medical records, Ochalek et al 12 found that the number of nonfatal opioid overdoses in an emergency department in Virginia increased from 102 in March-June 2019 to 227 in March-June 2020.…”

“…11 Positivity for non-prescribed fentanyl increased significantly among patients who tested positive for other drugs, including by 89% for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < .01 for all). 11 In a review of electronic medical records, Ochalek et al 12 found that the number of nonfatal opioid overdoses in an emergency department in Virginia increased from 102 in March-June 2019 to 227 in March-June 2020. In an issue brief published on October 31, 2020, the American Medical Association reported increase in opioid and other drugrelated overdoses in more than 40 states during the COVID-19 pandemic.…”

Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study

“…Alternative timelier data have been leveraged by several studies to explore the opioid crisis generally [ 6 , 7 ] and how it has shifted since the onset of the COVID-19 pandemic. Niles et al [ 8 ] analyzed national urine drug testing patterns before and during the pandemic, and reported a significant increase during the pandemic especially for fentanyl and heroin. Wainwright et al [ 9 ] similarly reported a significant increase in positive urine tests during the pandemic for all drugs tested among a convenience sample of patients with or at risk for substance use disorders.…”