The Perfect Storm: Covid-19 & Opioids

Submitted by Bill Claytor, DDS, MAGD

By mid-April 2020, the United States was experiencing two simultaneous events that had never happened in American history: all 50 states were under a State of Emergency and two major epidemics (Opioid and Covid-19) were ravishing our country.

The details and lasting effects of Covid-19 are still to be determined. The impact on employment, finances, isolation, anxiety, depression and drug use will contribute to more potential devastation the longer the pandemic lasts. What is readily apparent is its impact on the Opioid epidemic.

During this pandemic, the Mexican Cartels have been hit hard due to the decreasing supply of opioids. Since the border from Texas to California was on lockdown, the supply of Fentanyl into this country (98% of illicit Fentanyl is manufactured in China) dried up resulting in the cartels hiking their prices to try to make ends meet. This has resulted in mixing opioids with other substances resulting in purity issues. Selling drugs on the streets decreased due to public social distancing mandates resulting in less sales. Issues of opioid withdrawal during these times were feared while a concomitant rise in a substitute high was sought, mainly through methamphetamine which could be produced more locally. Finally, minimal money has been made available for drug treatment from the U. S. government during this time while treatment centers are trying to figure out how to manage treatment and social distancing.

Medication-assisted treatment (MAT), used to treat and maintain patients with chronic opioid use and relapse, was made more accessible during the pandemic by allowing telehealth visits for evaluations and check-ups. In March 2020, the White House Office of National Drug Control Policy amended the law stating patients could receive a 28 day supply of Suboxone (buprenorphine) and Methadone for home use¹ This was a big change, especially for Methadone since traditionally it has been given in a clinic setting which would make social distancing difficult. The availability of MATs was extremely important to help mitigate the potential for relapse during this time. Interestingly, one speculation about why businesses that sold alcohol were considered an “essential business” was so that people who had issues with alcohol didn’t go into withdrawal, resulting in further burden on the healthcare system.

On the recovery front, 12-step meetings across the world went virtual on platforms like Zoom, Go To Meeting, Microsoft Teams, etc. While these methods made accessibility easier for most, an estimated 10-15% did not have access to information technology (cell phones/computers) and couldn’t attend meetings virtually. The same issue already existed before Covid-19 by some not having access to transportation for meetings and harm reduction efforts (i.e., needle exchange programs).

One issue that was feared was the lack of ventilators. At the time, there was a short licit supply for hospitals of opioids, specifically Fentanyl, Morphine and Dilaudid. These drugs were used in conjunction with the ventilators to help coordinate breathing and relieve breathing issues. It is worth noting that licit opioid production has been down since the 1990s due to the epidemic so licit opioids were in short supply.

Lastly, the short and long-term effects on healthcare workers (HCWs) from Covid-19 are beginning to be manifested and the degree of and quantity of the effect appear to be potentially devastating. The mental health field is recognizing signs and symptoms similar to battlefield conditions with resultant Post Traumatic Stress Disorder. The extent of lasting HCW depression and anxiety plus the potential for suicide could result from the devastating consequences of this pandemic.

1 U.S. Department of Justice; www.justice.gov; Office on National Drug Control Policy Covid-19 Fact Sheet U.S. Attorneys; ONDCP Director Jim Carroll