To better understand the relationship between the COVID-19 pandemic and the drug epidemic, Quest investigators analyzed changes in prescription drug monitoring and drug positivity rates utilizing deidentified urine drug testing (UDT) results obtained from the Quest Diagnostics database. In total, 872,762 specimens from all 50 states and the District of Columbia were analyzed.
Weekly testing volume and drug positivity rates for nonprescribed fentanyl and other illicit drugs were compared between a baseline period (January 1, 2019-March 14, 2020) and a COVID-19 pandemic period (March 15-May 16, 2020).
Clinical drug testing declined rapidly during stay-at-home orders, starting the week beginning March 15, 2020. The weekly clinical drug testing volume fell approximately 70% from the baseline period to the trough (the week starting March 29) and then rose in subsequent weeks. Testing volume in the final week of the study was still 45% below the mean baseline weekly testing volume.
Positivity for nonprescribed fentanyl increased by 35% (from 4.3% to 5.8%, P < 0.01) during the pandemic compared to the baseline period. Significant increases in nonprescribed positivity during COVID-19 also were demonstrated for heroin (44%, P < 0.01), opiates (10%, P < 0.01), and marijuana (4%, P < 0.01).
Significant increases in nonprescribed fentanyl positivity were not confined to any single patient category; they occurred for both males (51%, P < 0.01) and females (16%, P < 0.01), and spanned all age groups 25 years and older (P = 0.02 or less).
The combination of nonprescribed fentanyl with other drugs also increased during the pandemic. Specifically, positivity for nonprescribed fentanyl increased by 89% among patients positive for amphetamines (P < 0.01), 48% for benzodiazepines (P < 0.01), 34% for cocaine (P < 0.01), 39% for opiates (P < 0.01), and 4% for heroin.
Study findings indicate that nonprescribed use of the drugs most responsible for the overdose epidemic in recent years (e.g., fentanyl) has increased greatly since the start of the pandemic. Perhaps even more troubling, the use of fentanyl drug combinations has been increasing as well.
Numerous factors may be contributing to increased use of certain nonprescribed drugs and dangerous drug combinations during the pandemic. At the onset of the pandemic, to help stop the spread of COVID-19 and prevent further deaths in healthcare settings, the CDC recommended that healthcare systems delay elective care.1 Although necessary to help mitigate the spread of the pandemic, these orders appear to have led to one of the most dramatic changes brought on by the convergence of the drug epidemic and the COVID-19 pandemic—the temporary discontinuation of testing for drug and alcohol misuse. The result is that many clinicians continue to prescribe controlled substances without drug testing and are therefore ‘‘flying blind,’’ lacking objective evidence to assess their patients for potential drug misuse. Making matters worse, many substance use disorder (SUD) treatment centers have been forced to close or scale back significantly during the pandemic shutdowns, leaving less access to these vital services for those in need.2
Present study findings indicate that clinical drug testing decreased during the COVID-19 pandemic, while nonprescribed positivity for fentanyl and many fentanyl drug combinations increased significantly. 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 study’s authors recommend a renewed focus in providing education and support to clinicians on the front lines, including reinforcing the importance of drug testing, the only objective measure of what drugs or substances patients are taking.
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