liebertpub.com: The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020
10/21/2020
Justin K. Niles, Jeffrey Gudin, Jeff Radcliff, and Harvey W. Kaufman
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.
Introduction
The drug epidemic
More than 750,000 people have died from a drug overdose in the United States from 1999 to 2018,1 with nearly 450,000 deaths involving prescribed or illicit opioids.2 The most recent yearly estimates indicate that the overdose epidemic peaked in 2017, with 70,723 reported deaths, followed by a 4.6% decrease in overdose deaths in 2018.3 Although progress has been made overall, fentanyl-related deaths threaten to bring deaths from drug overdoses to tragic new heights. The 12-month rolling count of provisional overdose deaths associated with non-methadone synthetic opioids (likely fentanyl) has increased every month since at least January 2015 (5766) through December 2019 (36,509).4
The coronavirus disease 2019 (COVID-19) pandemic
Another public health crisis, the COVID-19 pandemic (national emergency declared on March 13, 2020), has transformed daily life in the United States in innumerable ways. Stay-at-home orders began in various states in March, and by the end of April nearly all states warned their residents to stay home. To help prevent the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) also recommended postponement of medical prevention services that could not be performed virtually.5 An unfortunate consequence of these measures was a large decline in clinical drug testing (drug testing to assess compliance with prescribed drugs and/or use of non-prescribed/illicit drugs). Despite the mitigation efforts advocated by medical scientists, businesses, and government agencies, COVID-19 has spread rapidly across the United States, with more than 4.3 million confirmed cases resulting in more than 150,000 deaths as of late July 2020.6