COVID-19 and the Opioid Epidemic: Two Public Health Emergencies That Intersect With Chronic Pain

Abstract

The COVID-19 pandemic has affected the entire world and catapulted the United States into one of the deepest recessions in history. While this pandemic rages, the opioid crisis worsens. During this period, the pandemic has resulted in the decimation of most conventional medical services, including those of chronic pain management, with the exception of virtual care and telehealth. Many chronic pain patients have been impacted in numerous ways, with increases in cardiovascular disease, mental health problems, cognitive dysfunction, and early death. The epidemic has also resulted in severe economic and physiological consequences for providers. Drug deaths in America, which fell for the first time in 25 years in 2018, rose to record numbers in 2019 and are continuing to climb, worsened by the coronavirus pandemic. The opioid epidemic was already resurfacing with a 5% increase in overall deaths from 2018; however, the preliminary data show that prescription opioid deaths continued to decline, while at the same time deaths due to fentanyl, methamphetamine, and cocaine climbed, with some reductions in heroin deaths. The health tracker data also showed that along with an almost 88% decline in elective surgeries, pain-related prescriptions declined 15.1%. Despite increases in telehealth, outpatient services declined and only began returning towards normal at an extremely slow pace, accompanied by reduced productivity and increased practice costs. This review, therefore, emphasizes the devastating consequences of concurrent epidemics on chronic pain management and the need to develop best practice efforts to preserve access to treatment for chronic pain.

Keywords: COVID-19; Chronic pain; Concurrent epidemic; Epidemics; Interventional techniques; Opioid epidemic; Opioid use disorder.

Fig. 1

Weekly elective procedures as a % of baseline. Source: IQVIA: Medical Claims Data Analysis, 2020; Baseline = Average of procedures for period W/E 1/10/2020–2/28/2020. Elective procedures based on IQVIA custom analysis [47]. Estimated amounts for latest 2 weeks applied based on likely claims still to be received due to data latency or claim processing delays

Fig. 2

Percent change in filled prescriptions for selected drug classes, week ending May 1, 2020 vs. baseline and prior week. Source: IQVIA National Prescription Audit; Market definitions courtesy of IQVIA Institute for Human Data Science [47]

Fig. 3

The deadly toll of America’s opioid crisis. Source: Richter F. The deadly toll of America’s opioid crisis. Statista June 26, 2020. Accessed 7/14/2020. https://www.statista.com/chart/22118/drug-related-deaths-per-million-people/ [49]

Fig. 4

Number of opioid overdose deaths by category, 1999 to 2019. Source(s): For 1999–2018: National Institute on Drug Abuse. Overdose death rates. May 7, 2020 https://www.drugabuse.gov/relatedtopics/trends-statistics/ overdose-death-rates [38, 40]. For 2019: Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020 [41]. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Fig. 5

Total opioid prescriptions in the United States in millions, 2014–2019. Source(s): American Medical Association. Opioid Task Force 2020 Progress Report. Physicians’ Progress Toward Ending the Nation’s drug overdose and death epidemic. Accessed 7/27/2020. https://www.ama-assn.org/system/files/2020-07/opioid-task-force-progress-report.pdf [42]. IQVIA™ Institute for Human Data Science Releases 2019 Medicines Report on U.S. Drug Consumption; U.S. Rx Opioid Volume Declined 17% in 2018 – Largest Single-Year Drop Ever Recorded. Accessed 7/27/2020. https://www.iqvia.com/newsroom/2019/05/iqvia-institute-for-human-data-science-releases-2019-medicines-report-on-us-drug-consumption-us-rx-o [43]

Fig. 6

Results of burnout survey illustrating multiple adverse effects of COVID-19 pandemic on IPM practices. Reproduced with permission from Jha et al. The effect of COVID-19 on interventional pain management practices: A physician burnout survey. Pain Physician 2020; 23:S271-S282 [13]

Fig. 7

Drug-related deaths have risen in 2020 in states across the country (increase in drug-related deaths from 2019 through the first portion of 2020). All data are provisional. Definitions of what counts as a drug-related death vary by state. Data for Arizona, California, Florida, Minnesota, Tennessee, Texas, Washington, and Wisconsin include only a subset of counties within each state. Source: State and local health departments, coroners and medical examiners

Fig. 8

Dramatic growth in overdoses during pandemic