Clinical drug testing fell by over 50% in spring of 2020 due to the COVID-19 pandemic, according to a new study from Quest Diagnostics®. At the same time, the proportion of samples testing positive for dangerous illicit drugs and drug combinations rose.
“Nonprescribed use of the drugs most responsible for the overdose epidemic in recent years, for example fentanyl, has increased greatly since the start of the pandemic,” wrote the authors of the study, which was led by Harvey Kaufman, MD, senior medical director, healthcare analytics solutions at Quest Diagnostics. “Perhaps even more troubling, the use of fentanyl drug combinations has been increasing as well.” The study was published in the journal Population Health Management.
To assess the impact of the pandemic, the authors compared the number of requested tests, and their results, from the pandemic period to the period before it. The pre-pandemic period was defined as January 2019 to March 14, 2020. The pandemic period was defined as March 15 to May 16, 2020. The sample included 99% of all specimens submitted to Quest Diagnostics for analysis during this period, a total of 872,762 specimens from all 50 states and the District of Columbia.
“Clinical drug testing declined rapidly during stay-at-home orders,” the authors reported. The number of average weekly tests fell ~70% from the baseline period (pre-pandemic) to the trough in early April and remained lower throughout the pandemic period.
The overall rate of drug misuse—defined as either positivity for a nonprescribed or illicit drug, or non-positivity for a prescribed drug—declined slightly during the pandemic period, with misuse recorded in 49.9% of samples before the pandemic to 49.4% during it (P = .03).
However, this overall trend was bucked by significant increases in positivity for nonprescribed fentanyl, heroin, opiates, and marijuana.
Prevalence of Nonprescribed or Illicit Drugs
% Positivity
|
% Positivity
|
Drug
|
Pre-pandemic
|
During Pandemic
|
P value
|
Fentanyl
|
4.3
|
5.8
|
< .001
|
Heroin
|
0.9
|
1.3
|
< .001
|
Opiates
|
6.1
|
6.7
|
< .001
|
| Marijuana |
16.4 |
17 |
.007
|
Positivity rates for cocaine, amphetamines, oxycodone, and tramadol remained largely unchanged, while those for gabapentin and benzodiazepines fell.
Perhaps most troubling, the study found that the rates of dangerous drug combinations—specifically, the rate of co-occurrence of fentanyl with another drug—rose during the pandemic. For instance, in pre-pandemic specimens positive for cocaine, 47.6% were also positive for fentanyl; during the pandemic, 63.6% of cocaine-positive specimens were also positive for fentanyl.
Co-occurrence of Nonprescribed or Illicit Drugs
% Co-positive for Fentanyl
Drug
|
Pre-pandemic
|
During Pandemic
|
P value
|
Amphetamines
|
4.6
|
8.7
|
< .01
|
Benzodiazepines
|
5.4
|
8
|
< .01
|
Cocaine
|
47.6
|
63.6
|
< .01
|
Heroin
|
87.6
|
91
|
NS
|
Opiates
|
7.1
|
9.9
|
< .01
|
NS, not significant
|
“Numerous factors may be contributing to increased use of certain nonprescribed drugs and dangerous drug combinations during the pandemic,” the authors wrote, including the recommendation by the Centers for Disease Control and Prevention that healthcare systems delay elective care. “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.”
Published date: Dec. 31, 2020
