Misuse of fentanyl, heroin and nonprescribed opioids on the rise

Oct. 16, 2020

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, suggests a study from Quest Diagnostics Health Trends and summarized in a press release. The study was published online in the journal Population Health Management.

The study is based on analysis of more than 872,000 de-identified lab results representative of all 50 states and the District of Columbia, Quest said.

The researchers compared testing positivity rates for January 1, 2019-March 14, 2020, and March 15-May 16, 2020. Among individuals tested, the drug positivity rate increased 35 percent for non-prescribed fentanyl and 44 percent for heroin during the pandemic compared to the period prior to the pandemic. Nonprescribed opioids increased by 10 percent.

The study also found a surge in the positivity rate of combining drugs 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 percent), benzodiazepines (48 percent), cocaine (34 percent), and opiates (39 percent).

The findings suggest fentanyl is increasingly likely to be found in, or taken with, other drugs, resulting in dangerous drug combinations, according to Quest, adding that mixing often occurs without a user's knowledge.

From March to mid-May 2020, rates of drug testing declined significantly, compared to prior to the pandemic, including both for patients on medication-assisted treatment and those receiving in-person care. The rate of orders for clinical lab tests from Quest Diagnostics dropped by as much as 70 percent 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 percent at the height of the pandemic, compared to 49.9 percent prior to the pandemic -- similar to rates observed annually over the past four years. However, rates of drug testing in patients on medication-assisted treatment or receiving care in substance-use disorder care settings declined. The investigators theorize that these declines may be due to high-risk patients failing to continue to access healthcare services, possibly due to relapse during the pandemic.

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