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Triple Crises: COVID Pandemic, Mental Health, and Opioid Misuse

As the COVID-19 pandemic continues into its third year, it may be easy to lose site of the other major public health crises that predate it. But the nation’s mental health crisis and the opioid misuse crisis have continued on at the same time, and indeed have worsened in the past 2 years.

New data from Quest Diagnostics spotlight these ongoing emergencies and reveal important insights into how primary care physicians are thinking about how to keep their patients safe in the midst of these 3 crises.

The data come from the 2021 Quest Health Trends® Report, the latest in a series of reports designed to bring objective data to the understanding of the nation’s healthcare challenges. This year’s report combines analysis of nearly 5 million deidentified test results from Quest Diagnostics with results from a Harris Poll survey of over 500 physicians conducted in August 2021.

The report was authored by Jay G. Wohlgemuth, MD, senior vice president, R&D and Medical, and chief medical officer for Quest Diagnostics; Harvey W. Kaufman, MD, senior medical director and director, Health Trends Research Program for Quest Diagnostics; and Creighton Drury, chief executive officer, Partnership to End Addiction.

Key results include:

  • 94% of physicians report seeing more patients experiencing stress, anxiety, or other mental health issues because of the pandemic; more than two-thirds believe the pandemic has made the prescription drug crisis worse. 
  • That belief is backed up by testing data: In late 2019, just before the start of the pandemic, non-prescribed fentanyl, one of the most dangerous drugs available, was found in 26.7% of samples from patients receiving medication for opioid use disorder. Four months later, in April 2020, that figure had risen to 40.5%.
  • While telehealth is an important option for doctor and patient when in-person visits are not safe, it presents problems for monitoring patients at risk for opioid use disorder, according to physicians. Three-quarters (75%) of physicians noted that telehealth visits limit their ability to determine if patients are at risk for or are already misusing prescription drugs. While 91% felt they can recognize the signs of prescription drug misuse based on in-office interactions with patients, only 50% report the same level of confidence based on telehealth interactions.
  • Prescription drug misuse has risen during the pandemic, and illicit opioid positivity has risen. Data from Quest has shown that non-prescribed fentanyl was found in 4.3% of samples before the pandemic, but 5.8% during the pandemic, an increase of 35%. Similarly, heroin was found in 0.9% of samples before the pandemic and 1.3% during it, an increase of 44%.
  • 78% of physicians worry that patients will use illicit fentanyl if they cannot get a prescription opioid. According to the Centers for Disease Control and Prevention, fentanyl played a role in over 60% of drug overdose deaths in 2020.
  • 88% of physicians agreed that clinical drug testing is critical for preventing drug misuse. But there is some disagreement among physicians about how to use presumptive and definitive testing. 39% of physicians perform a presumptive test first, and then order a definitive test on the same sample if the results are negative or inconclusive. By comparison, 16% order only presumptive tests and 19% order definitive tests for all patients.
  • Presumptive tests, often administered as point-of-care tests, are typically inexpensive and return results almost immediately. However, they often have lower sensitivity and specificity than definitive tests. Quest researchers have shown they return a high rate of false-negative results for some of the most important drugs of concern, including fentanyl. Definitive testing can provide greater sensitivity, can confirm or refute presumptive test results, and reduces the occurrence of false-positive/false-negative results. However, definitive testing can take days to produce a result and is typically more expensive than presumptive testing.

“As recently as 2018, it appeared that drug overdoses were on the decline for the first time in over a decade,” wrote the authors of the Health Trends® report. “Sadly, this improvement was short-lived. Amid the pandemic’s days of self-isolation, delayed medical care, economic dislocation, and mental distress, drug misuse surged. In July 2021, the CDC reported that drug overdose deaths, fueled largely by fentanyl, rose to over 96,779 from March 2020-March 2021, the highest ever in a single year.

“This research reveals that physicians need comprehensive resources to identify risk, combat drug misuse, and care for suffering patients. Guidelines that are clear and flexible—harnessing not only medically appropriate clinical drug testing, but also telehealth, home-based care, and other consumer-centric approaches—will improve physicians’ ability to deliver the right care, at the right time, for the individual patient.”

Source:  Wohlgemuth JG, Kaufman HW, Drury C. Health Trends Drug Misuse in America 2021: Physician perspectives and diagnostic insights on the drug crisis and COVID-19