It made headlines on Oct. 14 when Franklin County, Ohio, coroner Anahi Ortiz announced that fatal drug overdoses jumped 73% in the first half of 2020, with a total of 437 deaths. Fentanyl was responsible for the bulk of the deaths, with 85% of the overdoses chalked up to fentanyl alone or combined with other drugs.
The county is the most populous in Ohio and is home of the state capital of Columbus. Ortiz also said that 52% of overdose deaths occurred in people aged 25-44, and 22% were 45-54. There was a 2% drop in the number of women who overdosed, 71% of the deaths were men, and about two-thirds of Franklin County’s drug fatalities were white.
Unfortunately, Dr. Ortiz’s experience is in line with new data showing that the upsurge in drug and alcohol abuse during the Coronavirus pandemic is happening everywhere in the United States and is much worse than earlier reports had suggested.
A new Quest Diagnostics Health Trends study indicates that misuse of fentanyl, heroin and nonprescribed opioids are on the rise, potentially due to the COVID-19 pandemic’s impact on healthcare access and support for individuals most at-risk for substance use disorder.
“Now, perhaps more than ever, given the increased stressors associated with the pandemic, we must maintain extra vigilance and not lose ground in our continued efforts to combat our nation’s drug abuse crisis,” the Quest researchers conclude.
In addition, they urge a renewed focus in providing education and support to treating clinicians on the front lines, including reinforcing the importance of drug testing, which they say is the only objective measure of what drugs or substances patients are taking.
Disturbing increases in drug abuse also were discovered to have taken place in 2019 before the pandemic began, it was recently reported by Quest, which is a nationwide diagnostic testing and information services company that publishes the annual data reports.
The national drug testing laboratory Millennium Health also found the pandemic was driving the rise in drug abuse. When it compared the period earlier this year from Jan. 1 to when the national emergency was declared on March 13, to the period from then to the end of May, there was an increase of 32% for nonprescribed fentanyl, 20% for methamphetamine, 12.5% for heroin and 10% for cocaine, accompanied by an 18% increase in suspected drug overdoses.
The new Quest study shows that the drugs of choice for abusers closely track the findings of the previous research. The new study looked at positive test rates for Jan. 1, 2019-March 14, 2020 and March 15-May 16, 2020 (during the onset of the COVID-19 outbreak).
Among individuals tested, the drug positivity rate increased 35% for non-prescribed fentanyl and 44% for heroin during the pandemic compared to the period prior to the pandemic. Nonprescribed opioids also increased by 10%.
Victims Combining Drugs
The study also found a massive surge in the positivity rate of drug combining with non-prescribed fentanyl during the pandemic compared to prior to the pandemic. Positivity for non-prescribed fentanyl increased substantially among specimens that were also positive for amphetamines (by 89%), benzodiazepines (48%), cocaine (34%), and opiates (39%).
These findings suggest fentanyl is increasingly likely to be found in, or taken with, other drugs, resulting in dangerous drug combinations. Drug mixing often occurs without a user’s knowledge. Fentanyl is a synthetic opioid that is 50 to 100 times more potent than morphine, a Schedule II prescription drug used to treat severe pain, but also a drug of abuse.
Most overdose deaths involving opioids such as fentanyl also involve concurrent use of benzodiazepines, cocaine, or methamphetamine.
There appears to be a difference in usage based on gender, Quest found. Use of illicit fentanyl in men increased 51%, from 5.7% in 2019 to 8.6% from mid-March to mid-May 2020. However, women’s positivity rate increased 16%, from 3% to 3.7%.
“COVID-19 interrupted non-essential patient care, but it hasn’t stopped drug misuse. We observe in the Quest data a striking increase in misuse of fentanyl in men compared to women during the initial phase of the pandemic,” says study co-author Jeffrey Gudin, M.D., senior medical advisor, drug monitoring at Quest Diagnostics. “Given the psychological, social and financial impacts of the COVID-19 crisis, more efforts are needed to ensure that patients are taking medications as prescribed. While the nation focuses on the pandemic, we must not lose sight of the ongoing drug misuse epidemic, which continues to kill upwards of 70,000 Americans each year.”
Co-author Harvey W. Kaufman, M.D., senior medical director, head of the Quest Health Trends Research Program, adds, "The COVID-19 pandemic has created the perfect storm for a rise in substance use disorders and other forms of prescription and illicit drug misuse. Stress, job losses and depression compounded with isolation and a lack of access to health services can trigger prescription medication overuse, illicit drug use or relapses,” he says.
Quest notes that from March to mid-May 2020 rates of drug testing had declined significantly compared to prior to the pandemic, including for both patients on medication-assisted treatment and those receiving in-person care. The investigators believe that these declines may be because high-risk patients were unable to maintain access to healthcare services, possibly due to relapse, during the pandemic.
The rate of orders for clinical lab tests from Quest dropped by as much as 70% weekly, indicating fewer patients were being screened for drug misuse during the early months of the pandemic.
“Yet, the rate of overall misuse held steady, with one in two patients showing signs of misuse of prescription or illicit drugs, specifically 49.4% at the height of the pandemic compared to 49.9% prior to the pandemic—similar to rates observed annually over the past four years,” Quest says.
“Our Health Trends data demonstrate the consequences of the pandemic, with dramatic increases of misuse of nonprescribed drugs at a time when fentanyl is also on the rise,” stresses Dr. Kaufman. “Our nation is grappling with a drug epidemic inside a pandemic. Patients and providers need increased access to support services, clinical care and drug testing to stop drug misuse from claiming more lives.”