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States are rushing to amend their laws surrounding opioid use disorder treatment as Covid threatens to exacerbate the opioid epidemic.
Preliminary data released last week from the Centers for Disease Control and Protection showed a record number of Americans – almost 72,000 – died from a drug overdose last year, a majority of which were opioid related.
And since the coronavirus pandemic began, experts have feared that the opioid crisis would get worse.
"The coronavirus pandemic is, unfortunately, expected to worsen the opioid overdose crisis," Barbara Andraka-Christou, an assistant professor of health management and informatics at the University of Central Florida, told NPR.
"Many individuals are experiencing triggers, such as family- or job-related stress, that may lead them to relapse," she said. "Many people are losing their jobs and the funds necessary to pay for lifesaving health care. Those of us working in public health research are very worried."
And early data shows their fears are justified.
The Washington Post reported that suspected overdoses jumped 18% in March, 29% in April and 42% in May. The figures are based on data from ambulance teams, hospitals, and police.
A report from the Overdose Data Mapping Application Program published in May showed fatal overdoses rose by almost 11.4% in comparison to last year.
Further, early research has shown that accessing addiction treatment is becoming more difficult, with a third of Americans noting disruptions in care and about 14% saying they’re unable to access treatment at all.
All these factors threaten any progress that’s been made when it comes to the opioid problem in America.
“Once the tsunami of Covid-19 finally recedes, we’re going to be left with the social conditions that enabled the opioid crisis to emerge in the first place, and those are not going to go away,” Mike Brumage, former director of the West Virginia office of drug control policy, told The Guardian.
Experts are now calling for governors and state legislators to take action to counteract the effects of the “collision of epidemics”.
“Bold efforts are needed to reduce the adverse effect that COVID-19 will have on progress in addressing opioid-related morbidity and mortality. In the absence of such efforts, we risk more catastrophic effects from these colliding epidemics,” wrote William Becker and David Fiellin in a paper published in the Annal of Internal Medicine journal.
On July 20, the American Medical Association (AMA) issued a list of recommendations to states including adopting new U.S. Drug Enforcement Administration (DEA) guidance, reducing barriers to patients to access essential pain medication and co-prescribe naloxone (commonly known as Narcan) to patients at risk of overdose.
Research has shown that access to buprenorphine, methadone and naloxone is the most effective at preventing opioid overdose.
Other studies have also shown that in states where co-prescribing naloxone is mandated it quickly and effectively expands the reach of naloxone to individuals in need as well as addresses economic and geographic disparities in naloxone provision.
Since AMA’s recommendations, federal and state officials have temporarily relaxed some of the strict regulations governing the medical treatment of opioid addiction.
And just last week the U.S. Food and Drug Administration (FDA) updated the opioid labelling requirements.
According to the statement released by the FDA, labeling for opioid pain medicine and medicine to treat opioid use disorder now “recommends that as a routine part of prescribing these medicines, health care professionals should discuss the availability of naloxone with patients and caregivers, both when beginning and renewing treatment.”
The FDA also said it’s working with other federal, state and local officials as well as health care professionals, patients and communities nationwide to help increase availability of naloxone and fight opioid overdoses.
“We know efforts to increase access to naloxone have the potential to put an important medicine for combatting opioid overdose and death in the hands of those who need it most – those at increased risk of opioid overdose and their friends and family,” said FDA Commissioner Stephen M. Hahn.
Right now, only eight states require naloxone to be co-prescribed with opioids but New York, South Carolina, Washington, Georgia, Illinois, and Kentucky all have pending co-prescribing legislation.
However, with the lack of regular state legislatures meetings and much, if not all, of their focus to COVID-19 related issues, the multi-step process to get the legislation passed will take quite some time.
As such, some are suggesting that more governors around the country should take note from New Jersey to start saving lives sooner.
In May, New Jersey’s Governor instituted an emergency administrative order during COVID-19 stating that doctors must co-prescribe naloxone to any patient continuously receiving opioids for chronic pain management.
“Co-prescribing naloxone gives chronic pain patients and their families ready access to a lifesaving antidote to reverse an opioid overdose,” said Sharon M. Joyce, Director of NJ CARES. “This is critically important at a time when the very necessary social distancing and stay-at-home orders are in effect to stop the spread of COVID-19.”
Critical, if not essential, as the “syndemic” could magnify the dangers of both.
As Director of the National Institute on Drug Abuse, Nora Volkow, explained not only does the current pandemic make overdosing more likely but also people with substance use disorder are especially susceptible to Covid-19.
“Bold efforts are needed to reduce the adverse effect that COVID-19 will have on progress in addressing opioid-related morbidity and mortality. In the absence of such efforts, we risk more catastrophic effects from these colliding epidemics,” she said.
