A new Quest Diagnostics Health Trends™ study indicates that misuse of fentanyl, heroin, and nonprescribed opioids are on the rise, potentially due to the COVID-19 pandemic’s impact on healthcare access and support for individuals most at-risk for substance use disorder. The full study, from researchers at Quest Diagnostics, is published online in the peer-reviewed journal Population Health Management.
Based on analysis of more than 872,000 deidentified lab results representative of all 50 states and the District of Columbia, the study is believed to be the largest to examine drug positivity rates before and during the first several months of the pandemic, and the first to examine drug -combining patterns based on lab data on a national scale.
Misuse of nonprescribed opioids and drug mixing surges
The researchers compared testing positivity rates for January 1, 2019-March 14, 2020 and March 15-May 16, 2020 (during the onset of the COVID-19 outbreak). Among individuals tested, the drug positivity rate increased 35% for nonprescribed fentanyl and 44% for heroin during the pandemic compared to the period prior to the pandemic. Nonprescribed opioids also increased by 10%.
The study also found a massive surge in the positivity rate of drug combining with nonprescribed fentanyl during the pandemic compared to prior to the pandemic. Positivity for nonprescribed fentanyl increased substantially among specimens that were also positive for amphetamines (by 89%), benzodiazepines (48%), cocaine (34%), and opiates (39%; P <0.01 for all comparisons).
These findings suggest fentanyl is increasingly likely to be found in, or taken with, other drugs, resulting in dangerous drug combinations. Drug mixing often occurs without a user’s knowledge.
Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, a Schedule II prescription drug used to treat severe pain, but also a drug of abuse. Most overdose deaths involving opioids such as fentanyl involve concurrent use of benzodiazepines, cocaine, or methamphetamine.
“The COVID-19 pandemic has created the perfect storm for a rise in substance use disorders and other forms of prescription and illicit drug misuse. Stress, job losses and depression compounded with isolation and a lack of access to health services can trigger prescription medication overuse, illicit drug use, or relapses,” said co-author Harvey W. Kaufman, MD, senior medical director, head of Health Trends Research Program, Quest Diagnostics.
Stay-at-home orders and reduced access to routine testing may hide true breadth of crisis
From March to mid-May 2020 rates of drug testing declined significantly compared to prior to the pandemic, including both for patients on medication-assisted treatment and those receiving in-person care. The rate of orders for clinical lab tests from Quest Diagnostics dropped by as much as 70% weekly, indicating fewer patients were being screened for drug misuse during the early months of the pandemic.
Yet, the rate of overall misuse held steady, with 1 in 2 patients showing signs of misuse of prescription or illicit drugs, specifically 49.4% at the height of the pandemic compared to 49.9% prior to the pandemic–-similar to rates observed annually over the past four years. However, rates of drug testing in patients on medication-assisted treatment or receiving care in substance use disorder care settings declined. The investigators theorize that these declines may be due to high-risk patients failing to continue to access healthcare services, possibly due to relapse, during the pandemic.
“Our Health Trends data demonstrate the consequences of the pandemic, with dramatic increases in misuse of nonprescribed drugs at a time when fentanyl is also on the rise. Our nation is grappling with a drug epidemic inside a pandemic. Patients and providers need increased access to support services, clinical care, and drug testing to stop drug misuse from claiming more lives,” Dr. Kaufman said.
Men at greatest risk for illicit fentanyl use
Use of illicit fentanyl in men increased 51%, from 5.7% in 2019 to 8.6% from mid-March to mid-May 2020. Women’s positivity rate increased 16%, from 3% to 3.7%.
“COVID-19 interrupted nonessential patient care, but it hasn’t stopped drug misuse. We observe in the Quest data a striking increase in misuse of fentanyl in men compared to women during the initial phase of the pandemic,” said study co-author Jeffrey Gudin, MD, senior medical advisor, drug monitoring, Quest Diagnostics. “Given the psychological, social, and financial impacts of the COVID-19 crisis, more efforts are needed to ensure that patients are taking medications as prescribed. While the nation focuses on the pandemic, we must not lose sight of the ongoing drug misuse epidemic, which continues to kill upwards of 70,000 Americans each year.”
Gabapentin misuse declined 21%
Nonprescribed gabapentin positivity declined 21% during the pandemic – although the rate of misuse remained relatively high, at 10.9%.
“A possible factor for the decline in nonprescribed use of gabapentin is a decline in physician visits resulting in fewer prescriptions,” Dr. Kaufman said.
For the complete study methodology, including strengths and limitations, refer to: https://www.liebertpub.com/doi/10.1089/pop.2020.0230.
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