As 2020 opened, a persistent and tragic opioid overdose epidemic was near the front of a list of national concerns in the US. Some 20+ million Americans are reported to have a substance use disorder and 2M of those misuse opioids.1 To further complicate things, the COVID-19 pandemic arrived early in the year, demanding a life changing public health and personal response for us all. For those struggling with an opioid use disorder, it no doubt contributes to the daily challenge of managing that condition.
The mental health impact of quarantine, isolation and related stress, access to care issues related to social distancing, etc. are not the least among these. Early indicators of all substance overuse in the COVID-19 period are concerning, as one national laboratory company, Millennium Health, has reported increases of 32% for the presence of non-prescribed fentanyl, 20% for methamphetamine, 10% for cocaine and 13% for heroin in a survey of 500,000 urine drug screens performed between mid-March and May 2020.1 A Nielsen report indicates that alcohol sales are up by nearly 27% in the same period and early data from a national tracking system at the University of Baltimore point to an 18% increase in suspected drug overdoses in this same period.3
While these trends are very concerning, its equally important that we recognize the critical human need for relief of intractable pain in those suffering from acute, traumatic and other chronic pain conditions. While prescription opioid use comes with a high requirement for caution and vigilance, we should avoid stigmatizing those in significant pain under the care of a skilled professional. Prescription opioid vigilance strategies at First Script include those which acknowledge evidence for the best pain management in initiation, continuing care, prescriber outreach and recommendation for referral to medication assisted treatment.
We are challenged, along with the nation at large, to balance a human concern for the welfare of those that struggle with substance use disorders and the tragedy of those related overdoses with the relief from pain that is judged to be necessary by the prevailing standard of care for pain conditions in injured workers.
1SAMSHA. Key Substance Use and Mental Health Indicators in the United States. Accessed at: https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
2 Millennium Health. Signals Report-COVID19 Special Edition Reveals Significant Changes in Drug Use During the Pandemic. Accessed at: https://www.millenniumhealth.com/news/signalsreportcovid/
3 University of Baltimore. ODMAP-Overdose Detection Mapping Application Program. Accessed at: http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf
4 American Medical Association. AMA urges CDC to revise opioid prescribing guideline. Accessed at: https://www.ama-assn.org/press-center/press-releases/ama-urges-cdc-revise-opioid-prescribing-guideline