The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020

Abstract

The convergence of the opioid epidemic and the coronavirus disease 2019 (COVID-19) pandemic has created new health care challenges. The authors analyzed changes in clinical drug testing patterns and results at a national clinical laboratory, comparing data obtained before and during the pandemic. Testing for prescription and illicit drugs declined rapidly during the pandemic, with weekly test volumes falling by approximately 70% from the baseline period to the trough (the week beginning March 29) before rising in subsequent weeks. Among individuals tested, positivity increased by 35% for non-prescribed fentanyl and 44% for heroin during the pandemic. Positivity for non-prescribed fentanyl increased significantly among patients positive for other drugs: by 89% for specimens positive for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < 0.01 for all comparisons). These findings suggest significant increases in dangerous drug combinations. Positivity for non-prescribed use of many other drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. Models adjusting for potential confounding variables, including medication-assisted treatment and treatment at a substance use disorder facility indicated that the risk for non-prescribed fentanyl positivity rose by more than 50% during the pandemic. In summary, these findings demonstrate decreased drug testing overall, with increased positivity for high-risk drugs and dangerous drug combinations. The convergence of the drug abuse epidemic and COVID-19 pandemic has led to an increased need for health care and public health resources dedicated to supporting vulnerable patients and addressing the underlying causes of these disturbing trends.

Keywords: COVID-19; SARS-CoV-2; clinical drug testing; fentanyl; opioid; substance use disorder.

FIG. 1.

Weekly volume of medMATCH tests with clinician-provided prescription drug(s), 2019 – May 2020. Green bars indicate before COVID-19 time period. Purple bars indicate during COVID-19 time period. COVID-19, coronavirus disease 2019.

FIG. 2.

Positivity rates for select non-prescribed drugs, before and during COVID-19 pandemic. Significance analyzed with the chi-square test.

FIG. 3.

Non-prescribed fentanyl positivity, by age group and sex. Chi-square test indicated significant differences in proportions between time periods for all groups (P ≤ 0.02) except the group aged 18–24 years.

FIG. 4.

Non-prescribed fentanyl positivity in specimens positive for other drugs. Chi-square test indicated significant differences between time periods for all drug combinations (P < 0.01) except heroin.

FIG. 5.

Multivariable logistic regression model: associations of predictive variables with non-prescribed fentanyl positivity. Model included 259,859 of 310,709 fentanyl-tested specimens with no missing values for any factor included in the model. Highlight text shows the Adjusted Odds Ratio of non-prescribed fentanyl during the COVID-19 pandemic. Variables were selected using a stepwise entry criterion of p < 0.05. HHS Region 1 includes specimens from Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. HHS Region 2 includes specimens from Ohio, Indiana, Illinois, Michigan, Wisconsin, and Minnesota. HHS, Health and Human Services.