As May comes to a close, COVID-19 had killed nearly 100,000 Americans so far this year. This must clearly remain the focus of public health policy. But there is another epidemic that used to make headlines: opioid overdoses. These two crises feed each other in deadly ways. We’re desperately seeking new tools to fight COVID-19 — from vaccines to antivirals to technology — but we already have underused tools to fight opioid deaths.
Almost 50,000 people died from opioid overdoses in 2018. The Health and Human Services inspector general concluded, “The 2020 COVID-19 pandemic makes the need to look at this population even more pressing.”
COVID likely detrimental to mental health
The COVID-19 pandemic tragically fuels the root causes of the opioid crisis, including depression, unemployment, poverty, social alienation and many other “conditions of despair.” Some research suggests that every 1 percentage point increase in the level of unemployment translates into a 3.6% increase in the opioid death rate. If the pandemic increases unemployment rates by 10-20 percentage points, this could generate a staggering increase in opioid deaths that would compound the tragedy.
But beyond there is another set of institutional factors that may cause the COVID-19 pandemic to worsen the opioid crisis, and that’s the change in the way we access health care. Thirty-two percent of opioid overdoses are from legally prescribed drugs such as oxycodone — roughly the same share as from heroin. Some of the deaths from legally prescribed drugs are in patients who take them for legitimate pain management. These patients need help to prevent abuse and death. Some deaths are in individuals using medications prescribed for someone else. This diversion is deadly.
Telemedicine is playing a vital role in providing access to health care during the pandemic — but it may paradoxically have the unintended consequence of accelerating these overdose deaths. Telemedicine is an important way to keep vulnerable patients out of health care facilities where they could pick up — or spread — disease. At both the state and federal levels, reimbursement and other rules have changed to encourage telemedicine, including allowing the prescription of opioids — even across some state lines. Approximately 76% of U.S. hospitals report that they are now connecting with patients using video, audio, chat, email and related technologies.
Telemedicine could be causing dangerous side effects
These new measures have the potential to increase opioid abuse, diversion and death. Without a face-to-face encounter, a physician has limited ability to evaluate the condition of a patient seeking pain management. And one of the few policy tools available to check for patients “opioid shopping” by going to multiple providers — state-level prescription drug monitoring programs (PDMPs) — does not work across state lines. It seems like we are already experiencing COVID-19’s impact on opioid overdoses, with multiple reports showing a sharp local increases in opioid deaths.
What should we do to mitigate this compounding death toll?
Of course, limiting the economic consequences of the COVID-19 pandemic through unemployment benefits and small business support is crucial on multiple fronts. But there are also much lower cost avenues that can help to forestall a rise in overdoses without limiting access to much needed care. State-level prescription drug monitoring programs must be strengthened, integrated into a national system and more easily accessed by prescribers. There are new technologies available to support desperately needed pain management while limiting the potential for diversion and overdose, including sophisticated pill tracking.
Policymakers can enable and incentivize adoption of new technologies in the same way that they have spurred adoption of telemedicine.
The COVID-19 crisis is unlikely to resolve quickly, and expanded access to telemedicine may be a boon for underserved patients even after it passes. We have tools available to mitigate the consequently higher risk of opioid overdoses without limiting access to needed care and medicines. If we act quickly, we can ensure that one public health crisis doesn’t further fuel another. We need to protect our communities from further hardship as best we can — particularly hardships so easy to forecast and to prevent.