COVID-19’s Effect on the Opioid Crisis

Medicare Set-Aside Blog, Opioids, Rx/Pharmacy on December 29, 2020
Posted by Leah King, PharmD, JD, Independent Pharmacy Consultant

For the past several months, you likely haven’t read or seen much about the opioid crisis. All of the information about the opioid crisis that once flooded your inboxes and social media feeds has seemingly been replaced with news related to the COVID-19 pandemic. While it can sometimes be said that no news is good news, that doesn’t appear to be the case with opioids. A closer look into recent data reveals that the opioid crisis has continued to rage throughout the nation and in fact, appears to be worsening. On October 31, the American Medical Association (AMA) issued a brief which highlighted widespread reports of dramatic increases in opioid-related deaths. As a result, the AMA is urging governors and state legislatures to take action by removing barriers to treatment for patients with chronic pain syndromes and substance abuse disorders.

For example, states can follow the lead of the federal Drug Enforcement Agency (DEA) by allowing controlled substances to be prescribed following a telemedicine evaluation. The DEA took this interim measure earlier this year because it recognized that many patients were confined to their homes due to various shelter-in-place orders in effect across the country. You may recall our blog that discussed the DEA’s interim measure (if you missed it, you can read it here).  The DEA’s action not only makes controlled substances more accessible for those patients with various types of chronic pain, but also allows buprenorphine and methadone to be more easily prescribed for patients with substance abuse disorder. States can remove other administrative barriers to treatment for substance abuse disorder, including prior authorization and step therapy requirements. States also have the option to remove administrative barriers that often exist for patients with chronic pain syndromes, such as limits on dosing, quantity, frequency and refills. Finally, states can encourage syringe services programs within local communities. Syringe services programs can help to provide intravenous drug users with sterile syringes and syringe disposal supplies, thereby reducing the incidence of hepatitis C and other bloodborne infections.  

The COVID-19 pandemic has led to societal changes that have been detrimental for numerous people. Small businesses have furloughed employees, or closed their doors altogether, resulting in higher unemployment rates. As schools and companies have implemented virtual operating models and community-based activities have been curbed, many people understandably feel isolated. Hospitals and nursing facilities have instituted no-visitor policies, making it impossible for many people to spend time with loved ones who are ill. All of these changes have contributed to higher rates of depression and mental instability, which are risk factors for substance abuse.

Taking all of these considerations into account, it’s relatively easy to understand why we’ve seen significant increases in opioid-related mortality since the COVID-19 pandemic started. While the steps recommended by the AMA will ensure that patients with chronic pain have access to medically necessary therapy, these measures also have the potential to make controlled substances more readily available to those who may abuse them. This is the delicate tightrope the opioid crisis has created,  putting necessary medications into the hands of those who need them, while trying to keep those same medications out of the hands of those who may abuse them.

Unfortunately, the situation which has resulted from the COVID-19 pandemic has made an already challenging situation even more difficult. As we look ahead to 2021, and the promise of a COVID-19 vaccine, we can only hope to reverse the problematic trend in opioid-related deaths that began earlier this year. As always, we will keep you informed with opioid-related updates here on our blog. You can access the full AMA issue brief here:  https://www.ama-assn.org/system/files/2020-11/issue-brief-increases-in-opioid-related-overdose.pdf.