Feature Article 1: Opioid Epidemic and The Pandemic

Since 2019 the rate of overdose from opioids including Fentanyl has increased significantly especially during the pandemic. The rate of Opioid addiction and overdose continues to rise despite efforts made by Prescription Drug Monitoring Programs (PDMPs). PDMPs are databases that pharmacies use to send prescription details to dispense medications (Castillo-Carniglia).  Due to the PDMPs making it so hard to get prescription opioids, many have turned to illegal opioids such as Fentanyl and Heroin.

Opioids and the pandemic

There have been many waves of extreme opioid use since the 90s. In the late 1990s and early 2000s, the first wave of the Opioid epidemic hit after prescription opioids like Oxycontin were reintroduced to the market by a major increase in the prescribing of these opioids. (Understanding the opioid overdose epidemic) Since the first wave there have been 2 more, the second one started around 2010 and was due to major heroin use. (Understanding the opioid overdose epidemic) The third wave began in 2013 and ended in 2016 this wave was caused by a rise in synthetic opioids like Fentanyl. (Understanding the opioid overdose epidemic) Since 2020 we have been having a 4th wave of opioid use and overdose.

A wave of opioids

 When the pandemic hit, it caused a huge spike in opioid use and overdoses. In 2020 between March and May, the number of overdoses rose by 42%. (Niles et al.)The Center for Disease Control and Prevention said “The number of people who died from a drug overdose in 2021 was over six times the number in 1999.” This was due to how hard it was to monitor prescriptions being dispensed. It was hard to monitor because of not having in-person doctor visits which caused some doctors to prescribe more opioids even if they weren't needed, this is because they had to take the patients' word for it and couldn't do a proper evaluation of whether they needed them or not. The pandemic also caused some doctors to shy away from prescribing opioids which caused more people to turn to drugs like Fentanyl. During the pandemic fentanyl was harder to get due to supply issues however drug traffickers stockpiled enough to sell fentanyl through the initial pandemic still. (Shelley) Many people turned to opioids due to limited access to help, increased stress due to isolation, and loss of mental health support. (Ghose et al.) This all shows how the pandemic affected the epidemic of opioids.

While Prescription Monitoring Drug Programs are helpful, they carry some serious consequences. Because PDMPs make it so hard to get prescription opioids they unintentionally open the doors for far more harmful illicit drugs such as Fentanyl to be abused. (Rich and Capodilupo) It has been found that there are ways to make fentanyl products that are more inexpensive such as capsules, “beans” and “buttons” making it easier to get access to fentanyl post-Covid. (Bolinski et al.) These types of drugs are not able to be monitored as they are made and distributed illegally. These are very dangerous as they can have massive amounts of Fentanyl and can be very fatal. Another one of the drugs people are turning to is Heroin.

Heroin, unlike Fentanyl, has no known medical use and is an illegal substance. (Crane) Heroin is a semi-synthetic drug made from the opium poppy plant. During Covid the use of Heroin was less than that of Fentanyl due to supply issues however there were still many fatalities from this drug. While this drug is less potent than Fentanyl it is still very hazardous and contributes to the rate of deaths from opioids.  Many people who used Heroin had underlying mental health issues caused by the isolation of the pandemic.

The pandemic of 2020 took a toll on a lot of people's mental health, as previously discussed the pandemic caused a rise in stress and anxiety from isolation. It also caused an increase in depression. When some people feel depressed or anxious they can turn to things like opioids to escape the emotional pain. This can be hazardous especially if they have a background of addiction or are at high risk of addiction. This is what led to the increase in opioid overdoses during this time.

After the pandemic of 2020, a lot of people struggled with opioid addiction and Methadone was used as a treatment for their addiction. Despite the fact it was supposed to help people stop abusing opioids it caused a rise in opioid overdoses. In just April 2020 alone there was an 95% increase in Opioid overdoses, 26.5% of which did not include use of a synthetic opioid.(Kleinman and Sanches) Males make up an astonishing 59.6% of overdoses that had Methadone involved.(Kleinman and Sanches) “Over 75% of the nearly 107,000 drug overdose deaths in 2022 involved an opioid.”(Understanding the opioid overdose epidemic) This is just one of many opioids abused during the Covid 19 pandemic that led to many overdoses as time went on.

Man addicted to opioids after the pandemic

Since the coronavirus of 2020, many have fallen victim to opioid addiction, which has claimed the lives of many. The pandemic was hard for all of us, it led to an increase in stress and depression because of isolation. This made it harder for those already struggling with active addiction not to mention those who were recovering addicts. During hard times like a pandemic, it's important to have a support system even if you don't have an addiction having that support can prevent one from forming. The pandemic led a lot to a very dark place and opioids helped fill the void. During the pandemic there were about 72,809 deaths from overdose and of those men made up about 68% of that. (Kleinman and Sanches) This could potentially be prevented if more people were aware of the dangers of opioids and had a support system during the Covid 19 pandemic. The Center of disease control and Prevention (CDC) says that they are focused on many things some of those being “Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids.” and “Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.” These will help tremendously with building support and access to help for those who may be struggling with addiction.

Bolinski, Rebecca S, et al. “The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings.” International Journal of Environmental Research and Public Health, U.S. National Library of Medicine, 16 Feb. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8872091/. 

Castillo-Carniglia, Alvaro. “Prescription Drug Monitoring Programs and Opioid Overdoses: ... : Epidemiology.” Epidemiology, Lippincott, Mar. 2019, journals.lww.com/epidem/fulltext/2019/03000/Prescription_Drug_Monitoring_Programs_and_Opioid.9.aspx. 

Crane, Marisa. “Fentanyl vs. Heroin: An Opioid Comparison.” American Addiction Centers, 19 July 2024, americanaddictioncenters.org/opioids/fentanyl/similarities. 

Ghose, Rina, et al. “Impact of the Covid-19 Pandemic on Opioid Overdose Deaths: A Spatiotemporal Analysis - Journal of Urban Health.” SpringerLink, Springer US, 18 Feb. 2022, link.springer.com/article/10.1007/s11524-022-00610-0. 

Kleinman, Robert A, and Marcos Sanches. “Methadone-Involved Overdose Deaths in the United States before and during the COVID-19 Pandemic.” Drug and Alcohol Dependence, U.S. National Library of Medicine, 1 Jan. 2023, www.ncbi.nlm.nih.gov/pmc/articles/PMC9674402/. 

niles, justin k, et al. “The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020.” Population Health Managment, 5 Feb. 2021, www.liebertpub.com/doi/10.1089/pop.2020.0230. 

Patel, Kavya, et al., directors. An Epidemic in a Pandemic: The Opioid Crisis During the COVID-19 Pandemic. Demystifying Medicine McMaster, 21 Dec. 2020, https://www.youtube.com/watch?v=AlblMrz2TOw. Accessed 13 Oct. 2024.

Rich, Jacob  James, and Robert Capodilupo. “Prescription Drug Monitoring Programs: Effects on Opioid Prescribing and Drug Overdose Mortality.” Reason Foundation, 29 July 2021, reason.org/policy-study/prescription-drug-monitoring-programs-effects-on-opioid-prescribing-and-drug-overdose-mortality/. 

Shelley, Louise. “Fentanyl, COVID-19, and Public Health.” Los Angeles Times, Los Angeles Times, 24 Apr. 2020, www.latimes.com/world-nation/story/2020-04-24/wuhan-china-coronavirus-fentanyl-global-drug-trade. 

“Understanding the Opioid Overdose Epidemic.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 5 Apr. 2024, www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html.