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COVID-19 and the Opioid Crisis – How This Pandemic is Shaping the Opioid Crisis in 2020

This blog post is taken from a recent Webinar featuring Jill Warrington, MD, PhD., Chief Medical Officer, Aspenti Health and Assistant Professor, Robert Larner College of Medicine, University of Vermont.

The Opioid crisis was already a significant problem for healthcare before the COVID-19 pandemic began to change everything. Dr. Jill Warrington began her discussion of how COVID-19 has reshaped the opioid crisis with a look back at what was happening before COVID-19 really emerged as a threat in 2019. “It is important to understand where we were then, if we are to really understand the impact that COVID-19 has had on the opioid crisis,” said Warrington.

The Baseline -2019

Warrington and her colleagues use a number of metrics to help them evaluate the status of various opioid-related issues. There are three metrics on which Dr. Warrington and her colleagues are particularly focused. They are:

  1. The Number of Buprenorphine-Waivered Providers. This measure serves as a proxy to help researchers understand treatment capacity. Warrington shared that this number has increased exponentially over the last 15 years as the government has become more flexible in issuing the waivers and healthcare systems are increasingly recognizing the importance of buprenorphine in treating patients with opioid use disorder.

    However, Warrington points out that this metric has some limitations. First, there are still many patients on waiting lists for treatment, so it is not necessarily a real indicator of system capacity. Secondly, Warrington points out that just 10% to 30% of SUD (Substance Use Disorder) patients are in care which means that 70% to 90% of those patients are not being served despite a much-expanded network of buprenorphine-waivered [BP1] providers.

  2. Opioid Prescribing Rates. This measure helps researchers determine the risk for patients of developing opioid use disorder. Warrington points out that great strides have been made in opioid prescribing rates.

    There has been a steady decline in this metric since 2012 – the peak prescribing year. However, Warrington points out that providers are still prescribing enough opioids to support 50% of the population. While the momentum is in the right direction, the US has still not made the progress seen in some other countries.

  3. Opioid-Related Overdose Deaths. Warrington describes this as the most direct measure of the impact of the opioid crisis and therefore the most important. The news on this metric is somewhat mixed. Based on data from 2015-2020, the rate of opioid-related overdose deaths continues to rise, however, the rise in the rate has slowed somewhat. Dr. Warrington mentions that although they’ve seen progress in drug overdose statistics, this is an unsustainable trajectory.

20202 – The Epidemic Within the Pandemic

Warrington describes the ecosystem that supports opioid use disorder patients as “already fragile,” as 2019 rolled over into 2020. There are more buprenorphine providers, but the number still falls short of what is needed. There have been reductions in the number of opioid prescriptions, but the reduction is probably not sufficient. And finally, while somewhat abated, the number of overdoses is still rising.

According to the American Medical Association, as of June 18, 2020, there were more than 30 states reporting increases in opioid-related deaths, mental health crises, suicide, and relapse. In addition, there are some rather alarming statistics on the use of drugs and alcohol during the pandemic. Warrington shared that:

  • There has been a 250% increase in online alcohol sales.
  • The increase in episodes of binge drinking is estimated to be 25%.
  • It is estimated that there has been a 40% increase in the use of medications for non-medical reasons.
  • There has been a 43% increase in the use of illicit drugs.

While these figures may be somewhat shocking, they probably should not really surprise us. The pandemic has caused considerable economic and social distress with the loss of jobs creating financial stress for many and the loss of viable options for childcare creating considerable stress for those that still do have jobs. Concerns about health and the health of family members also creates additional stress.

In addition, while the healthcare delivery system including providers, payors, and in some cases, the government, has responded to the pandemic in a truly heroic fashion, it was also fundamentally unprepared to deal with the crisis. Treatment centers that were underfunded found themselves struggling and most reported having to make reductions in their services in order to remain open.

Lastly, and perhaps most significantly, there are factors specific to addiction that make the pandemic more dangerous for these patients. Factors such as social isolation, the exacerbation of existing mental health issues and the risk of COVID-19 complications. To learn more about these factors and Warrington’s recommendations for moving forward, click here to access the entire webinar.

Improve Patient Outcomes

HealthStream provides training solutions focused on improved patient outcomes. Using the right tools to help clinicians make informed decisions and reduce costly mistakes minimizes risk while maximizing competence. An outcomes-based delivery system requires it.  HealthStream has partnered with Aspenti Health to offer a comprehensive and cost-effective way to drive the responsible administration of opioids and effectively identify and address opioid use disorder. Learn more at HealthStream.com/Aspenti

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