Lower levels of testing and higher positivity rates, higher rates of dangerous drug combination use, and increases in fatal and non-fatal overdoses during the coronavirus disease 2019 (COVID-19) pandemic reveal a need for more resources to address the opioid epidemic in the United States.
Prescription and illicit drug testing rates declined during the COVID-19 pandemic in 2020, according to a study published in the journal Population Health Management. Many in-person health services were unavailable following pandemic stay-at-home orders, including in-person drug testing, to prevent the spread of the virus.
Harvey W Kaufman, MD, MBA, FCAP, senior medical director, information ventures and office of chief medical officer at Quest Diagnostics conducted the study along with colleagues. The authors analyzed changes in testing patterns for prescription and illicit drugs at Quest Diagnostics, a national clinical laboratory. Researchers compared data sets from before and during the COVID-19 pandemic by examining urine specimen results from Quest Diagnostics medMATCH® reporting method, which indicates whether provider-prescribed or other drugs are found in the samples.
Study authors used specimens collected between January 1, 2019 and May 16, 2020. Specimens that had no record of age, or that were collected from patients under 18 years of age were excluded. Researchers also excluded specimens with abnormal specimen validity testing results and those that tested negative for drugs. The authors noted that not all specimens were tested for all drugs as choice of test varied among medical providers. A total of 872,762 specimens were used in the study; specimens came from all 50 US States and the District of Columbia.
Kaufman and colleagues said the volume of weekly drug testing declined by 70% from the baseline of January 1, 2019 to March 29, 2020 before rebounding in the following weeks. Testing showed increases in substance use during the pandemic: positive tests for non-prescribed fentanyl rose by 35%, and positive tests for heroin rose by 44%. In addition, the authors reported that “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 < .01 for all comparisons).”1 There also was an increase in dangerous drug combination use, the authors said. Researchers suggested these rates are a direct result of the COVID-19 pandemic, and said that social distancing, stress, loneliness, depression, and job loss contributed to increases. They also said isolation makes drug use more dangerous during this time, as it decreases the chances of a bystander being present to call for help or administer naloxone in the event of an overdose.
Test positivity rates stayed the same for many other non-prescribed drugs or decreased when compared to patterns seen prior to COVID-19. “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,” study authors said.1
They also reported an increase in submissions to the Overdose Mapping Application Program (ODMAP); suspected overdose deaths rose 18% in March, 29% in April, and 42% in May when compared to the same period in 2019. ODMAP also reported an overall 11.4% increase in overdose deaths and an 18.6% increase in non-fatal overdoses in 2020.
In an interview with Contemporary OB/GYN® Kaufman said an important takeaway for providers is that “the pandemic and the associated social restrictions and stresses may have led many patients to engage in potentially dangerous drug behaviors.” He said that in June and September 2020 the American Society of Addiction Medicine (ASAM) issued guidance suggesting other ways of monitoring drug adherence that could be used instead of laboratory testing. “Predicting which patients are taking drugs can be challenging.Patient evaluation and drug testing, especially urine drug testing, are critical tools to help establish what drugs patients may be using,” Kaufman said.
For important steps that need to be taken following this study, Kaufman told Contemporary OB/GYN® that providers “need to re-engage with patients who have skipped or delayed healthcare. Although this specific study focused on the epidemic of drug misuse, patients have postponed many healthcare visits.” He said that to get patients active in their care again, “we need to find creative ways, such as with telemedicine, to check in with patients who remain hesitant or in denial.”
He added that in a separate Quest Diagnostics Health Trends™ survey, researchers worked with the Harris Poll and found that 2 in 5 patients were concerned they had an undiagnosed medical condition. “With delayed care, some patients will present at more advanced stages of disease, will require more aggressive therapy, and have worse outcomes. We have observed decreases in cancer diagnoses, testing for sexually transmitted infections, and most other routine laboratory testing,” Kaufman explained in the interview.
“We recognize the role that women often have as the central caregiver in their immediate and extended families. Women are more likely to prioritize others’ health over their own. We need to address their needs so they can be healthy themselves and can continue to support their families and communities,” Kaufman told Contemporary OB/GYN®. He said the pandemic has illuminated health inequities and collaboration is needed to find new ways to provide health care services to all who are in need.
"And we must not forget ourselves,” Kaufman stressed.“As healthcare providers, we need to take care of ourselves including addressing our personal needs for healthcare and need to take time to recuperate – to avoid burnout.”
He said drug use may be in response to the stresses everyone faces, and the pandemic has exacerbated these stresses.“Medical evaluation, testing, and treatment are critical if we are to combat the drug epidemic now and moving forward as we continue to battle with COVID-19.”
Niles JK, Gudin J, Radcliff J, Kaufman HW. The opioid epidemic within the COVID-19 pandemic: drug testing in 2020. Popul Health Manag. 2021;24(S1):S43-S51. doi:10.1089/pop.2020.0230