Opioid Crisis during the COVID-19 Pandemic

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Coronaviruses (CoV) and COVID-19 Pandemic".

Deadline for manuscript submissions: closed (31 March 2023) | Viewed by 9295

Special Issue Editor


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Guest Editor
School of Pharmacy, Chapman University, Irvine, CA 92618, USA
Interests: substance use; pharmacoepidemiology; real-world data; global health

Special Issue Information

Dear Colleagues,

Half a million deaths worldwide are attributable to drug use, and opioid overdose accounted for more than 30% of those deaths. Like many other countries, America witnessed a spike in drug overdose deaths since the start of COVID-19. In the United States, opioid overdose is mainly driven by illicitly produced synthetic opioids and misuse of opioid prescriptions. Despite the availability of medication-assisted treatment (MAT) with buprenorphine, methadone, and naloxone for opioid use disorder (OUD), the COVID-19 pandemic created unique challenges for access to treatment for people with OUD and those in recovery. Therefore, it is critical to understand the multidimensional landscapes of opioid use in the age of COVID-19 to mitigate the opioid overdose crisis and ensure adequate access to opioids for patients needing appropriate pain management.

As an internationally well-recognized journal with global impact, Healthcare is releasing a Special Issue to investigate the global opioid epidemic and aims to provide high-quality investigations. This Special Issue aims to seek out the most contemporary evidence-based studies considering health utilization and policy of opioids, MAT, and cancer treatment in the COVID-19 era. Some topics of this Special Issue include, but are not limited to, the following:

  • Opioid-related policy in the age of COVID-19;
  • Risk factors for opioid overdose;
  • MAT provision, coverage, and financing models;
  • Optimizing the use of opioid prescriptions in the management of cancer pain;
  • Challenges and responses of healthcare systems/sectors;
  • New technology in opioid use disorder diagnosis and management;
  • Others.

Dr. Sherry Yun Wang
Guest Editor

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Keywords

  • Opioid
  • Cancer treatment
  • Medication-assisted treatment
  • COVID-19
  • Policies
  • Machine learning

Published Papers (6 papers)

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Research

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15 pages, 249 KiB  
Article
Factors Affecting Initiation and Retention of Medication-Assisted Recovery (MAR) within a Pilot Pharmacist-Involved Practice Model at a Federally Qualified Healthcare Center (FQHC) during the COVID-19 Pandemic
by Tiffany Nguyen, Thomas Craig Cheetham, Souhiela Fawaz, Richard Beuttler and Sharon Xavioer
Healthcare 2023, 11(10), 1393; https://doi.org/10.3390/healthcare11101393 - 11 May 2023
Viewed by 960
Abstract
Background: During the COVID-19 pandemic, opioid-related overdose deaths increased. Although Medication-Assisted Treatment or Recovery (MAT or MAR) is available, initiation and retention rates vary. The goal of this study was to evaluate clinical, demographic, and Social Determinant of Health factors affecting MAR initiation, [...] Read more.
Background: During the COVID-19 pandemic, opioid-related overdose deaths increased. Although Medication-Assisted Treatment or Recovery (MAT or MAR) is available, initiation and retention rates vary. The goal of this study was to evaluate clinical, demographic, and Social Determinant of Health factors affecting MAR initiation, on-time initiation of medications, and successful retention in the program. The secondary goal was to evaluate the impact of a novel interprofessional practice model incorporating pharmacists. Methods: A retrospective analysis was conducted using electronic health record data from a pilot MAR Program initiated within a California Federally Qualified Healthcare Center. Results: From September 2019 to August 2020, 48 patients enrolled into the program. On-time initiation of medications occurred in 68% of patients and average program retention was 96.4 ± 95.8 days. Patients currently using opioids (p = 0.005) and those receiving supportive medications (p = 0.049) had lower odds of on-time MAR initiation. There were no statistically significant factors associated with successful retention in the program. The number of visits with members of the interprofessional team did not significantly affect on-time initiation or successful retention. Conclusions: Current opioid use and receipt of supportive medications were associated with lower on-time medication initiation. Further studies are warranted to explore additional factors which may affect initiation and retention. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
14 pages, 1464 KiB  
Article
Interrupted Time Series Analysis: Patient Characteristics and Rates of Opioid-Use-Disorder-Related Emergency Department Visits in the Los Angeles County Public Hospital System during COVID-19
by Emily Johnson, Sarah Axeen, Aidan Vosooghi, Chun Nok Lam, Ricky Bluthenthal and Todd Schneberk
Healthcare 2023, 11(7), 979; https://doi.org/10.3390/healthcare11070979 - 29 Mar 2023
Viewed by 1516
Abstract
The COVID-19 pandemic led to disruptions in care for vulnerable patients, in particular patients with opioid use disorder (OUD). We aimed to examine OUD-related ED visits before and during the COVID-19 pandemic and determine if patient characteristics for OUD-related ED visits changed in [...] Read more.
The COVID-19 pandemic led to disruptions in care for vulnerable patients, in particular patients with opioid use disorder (OUD). We aimed to examine OUD-related ED visits before and during the COVID-19 pandemic and determine if patient characteristics for OUD-related ED visits changed in the context of the pandemic. We examined all visits to the three public safety net hospital EDs in Los Angeles County from April 2019 to February 2021. We performed interrupted time series analyses examining OUD-related ED visits from Period 1, April 2019 to February 2020, compared with Period 2, April 2020 to February 2021, by race/ethnicity and payor group. We considered OUD-related ED visits as those which included any of the following: discharge diagnosis related to OUD, patients administered buprenorphine or naloxone while in the ED, and visits where a patient was prescribed buprenorphine or naloxone on discharge. There were 5919 OUD-related ED visits in the sample. OUD-related visits increased by 4.43 (2.82–6.03) per 1000 encounters from the pre-COVID period (9.47 per 1000 in February 2020) to the COVID period (13.90 per 1000 in April 2020). This represented an increase of 0.41/1000 by white patients, 0.92/1000 by black patients, and 1.83/1000 by Hispanic patients. We found increases in OUD-related ED visits among patients with Medicaid managed care of 2.23/1000 and in LA County safety net patients by 3.95/1000 ED visits. OUD-related ED visits increased during the first year of the COVID pandemic. These increases were significant among black, white, and Hispanic patients, patients with Medicaid managed care, and LA County Safety net patients. These data suggest public emergency departments served as a stopgap for patients suffering from OUD in Los Angeles County during the pandemic and can be utilized to guide preventative interventions in vulnerable populations. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
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15 pages, 767 KiB  
Article
Positive Association between Peri-Surgical Opioid Exposure and Post-Discharge Opioid-Related Outcomes
by Kibum Kim, Joseph E. Biskupiak, Jennifer L. Babin and Sabrina Ilham
Healthcare 2023, 11(1), 115; https://doi.org/10.3390/healthcare11010115 - 30 Dec 2022
Viewed by 1270
Abstract
Background: Multiple studies have investigated the epidemic of persistent opioid use as a common postsurgical complication. However, there exists a knowledge gap in the association between the level of opioid exposure in the peri-surgical setting and post-discharge adverse outcomes to patients and healthcare [...] Read more.
Background: Multiple studies have investigated the epidemic of persistent opioid use as a common postsurgical complication. However, there exists a knowledge gap in the association between the level of opioid exposure in the peri-surgical setting and post-discharge adverse outcomes to patients and healthcare settings. We analyzed the association between peri-surgical opioid exposure use and post-discharge outcomes, including persistent postsurgical opioid prescription, opioid-related symptoms (ORS), and healthcare resource utilization (HCRU). Methods: A retrospective cohort study included patients undergoing cesarean delivery, hysterectomy, spine surgery, total hip arthroplasty, or total knee arthroplasty in an academic healthcare system between January 2015 and June 2018. Peri-surgical opioid exposure was converted into morphine milligram equivalents (MME), then grouped into two categories: high (>median MME of each surgery cohort) or low (≤median MME of each surgery cohort) MME groups. The rates of persistent opioid use 30 and 90 days after discharge were compared using logistic regression. Secondary outcomes, including ORS and HCRU during the 180-day follow-up, were descriptively compared between the high and low MME groups. Results: The odds ratios (95% CI) of high vs. low MME for persistent opioid use after 30 and 90 days of discharge were 1.38 (1.24–1.54) and 1.41 (1.24–1.61), respectively. The proportion of patients with one or more ORS diagnoses was greater among the high-MME group than the low-MME group (27.2% vs. 21.2%, p < 0.01). High vs. low MME was positively associated with the rate of inpatient admission, emergency department admissions, and outpatient visits. Conclusions: Greater peri-surgical opioid exposure correlates with a statistically and clinically significant increase in post-discharge adverse opioid-related outcomes. The study findings warrant intensive monitoring for patients receiving greater peri-surgical opioid exposure. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
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12 pages, 668 KiB  
Article
Prescription Opioid Use among Patients with Chronic Noncancer Pain before and after the COVID-19 Outbreak in Taiwan: A Multicenter Prospective Observational Study
by Jia-Lin Chen, Shung-Tai Ho, Wei-Zen Sun, Yu-Chuan Tsai, Kuang-I Cheng, Yen-Chin Liu, Yi-Jer Hsieh, Yeong-Ray Wen, Po-Kai Wang, Chun-Sung Sung, Chun-Chang Yeh and Tso-Chou Lin
Healthcare 2022, 10(12), 2460; https://doi.org/10.3390/healthcare10122460 - 06 Dec 2022
Viewed by 1397
Abstract
Background: The COVID-19 outbreak disrupted medical access for patients receiving chronic opioid therapy. This study investigated their prescription opioid dosages before and after the 2020 outbreak in Taiwan. Methods: A prospective questionnaire survey was conducted among registered outpatients receiving long-term opioids before July [...] Read more.
Background: The COVID-19 outbreak disrupted medical access for patients receiving chronic opioid therapy. This study investigated their prescription opioid dosages before and after the 2020 outbreak in Taiwan. Methods: A prospective questionnaire survey was conducted among registered outpatients receiving long-term opioids before July 2019 in Taiwan. The questionnaire included items from the Taiwanese Brief Pain Inventory and quality of life assessment. Follow-up surveys in outpatient departments through October 2020 were conducted to collect opioid prescription data. Results: After a mean of 531 days, the questionnaire responses of 103 of the initial 117 respondents were reviewed. Daily opioid doses decreased for 31 respondents (30.1%), remained roughly equivalent (defined as ±2.5%) for 27 (26.2%), and increased for 45 (43.7%) after the first wave of the pandemic. The use of strong opioids and nonopioid medications did not significantly differ among the three groups, but less fentanyl patch use was noted in the decreased-dose group after the outbreak. More than 70% of the patients received daily high-dose opioids (≥90 morphine milligram equivalents); moreover, 60% reported constipation. No deaths due to opioid overdose occurred during the study period. Conclusions: The COVID-19 outbreak in 2020 did not interrupt access to long-term opioid prescriptions for most registered patients with chronic pain in Taiwan. Less fentanyl patch use was observed in participants whose opioid dose was tapering. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
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9 pages, 950 KiB  
Article
Effect of Didactic Training on Barriers and Biases to Treatment of Opioid Use Disorder: Meeting the Ongoing Needs of Patients with Opioid Use Disorder in the Emergency Department during the COVID-19 Pandemic
by Emily Johnson, Maria Bolshakova, Aidan Vosooghi, Chun Nok Lam, Rebecca Trotzky-Sirr, Ricky Bluthenthal and Todd Schneberk
Healthcare 2022, 10(12), 2393; https://doi.org/10.3390/healthcare10122393 - 29 Nov 2022
Cited by 2 | Viewed by 1536
Abstract
In the wake of COVID-19, morbidity and mortality due to Opioid Use Disorder (OUD) is beginning to emerge as a second wave of deaths of despair. Medication assisted treatment (MAT) for opioid use disorder MAT delivered by Emergency Medicine (EM) providers can decrease [...] Read more.
In the wake of COVID-19, morbidity and mortality due to Opioid Use Disorder (OUD) is beginning to emerge as a second wave of deaths of despair. Medication assisted treatment (MAT) for opioid use disorder MAT delivered by Emergency Medicine (EM) providers can decrease mortality due to OUD; however, there are numerous cited barriers to MAT delivery. We examined the impact of MAT training on these barriers among EM residents in an urban, tertiary care facility with a large EM residency. Training included the scripted and standardized content from the Provider Clinical Support System curriculum. Residents completed pre- and post-training surveys on knowledge, barriers, and biases surrounding OUD. We performed Wilcoxon matched-pairs signed-ranks test to detect statistical differences. Of 74 residents, 49 (66%) completed the pre-training survey, and 34 (69%) of these completed the follow-up survey. Residents reported improved preparedness to treat aspects of OUD across all areas queried, reported decreased perception of barriers to providing MAT, and increased comfort prescribing naloxone, counseling patients, prescribing buprenorphine, and treating opioid withdrawal. A didactic training on MAT was associated with residents reporting improved comfort providing buprenorphine and naloxone. As the wake of morbidity and mortality from both COVID and OUD continue to increase, programs should offer dedicated training on MAT. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
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11 pages, 7917 KiB  
Brief Report
Geospatial Analysis of Opioid Dispensing Patterns in California: A 2021 Real-World Study
by Hongxia Lu, Jianwei Zheng and Yun Wang
Healthcare 2023, 11(12), 1732; https://doi.org/10.3390/healthcare11121732 - 13 Jun 2023
Cited by 1 | Viewed by 1435
Abstract
The misuse and abuse of opioids has become a serious public health threat in the United States. The state of California has been hit particularly hard by the opioid epidemic, with a noticeable increase in opioid-related fatalities and hospitalizations. This brief report paper [...] Read more.
The misuse and abuse of opioids has become a serious public health threat in the United States. The state of California has been hit particularly hard by the opioid epidemic, with a noticeable increase in opioid-related fatalities and hospitalizations. This brief report paper aims to contribute to the growing literature by conducting a geospatial analysis of opioid dispensing patterns in California in 2021. The primary objective was to identify areas characterized by high-risk opioid dispending patterns and explore possible contributing factors. This retrospective study analyzed data from over 7 million records of opioid and benzodiazepine prescriptions dispensed by outpatient pharmacies in California in 2021. A series of generalized linear regression models was employed to assess the impact of neighborhood characteristics on opioid recipients and high-risk opioid dispensing. The study defined high-risk opioid dispensing behavior as: (1) multiple provider episodes, (2) overlapping opioid prescriptions for seven or more days, (3) overlapping opioid and benzodiazepine prescriptions for seven or more days, and (4) a high standardized dosage of opioid prescriptions per month. The study identified variables associated with high-risk opioid dispensing behaviors, including age, population density, income, and housing-related variables, as well as marital status and family-related variables. The study uncovered that there are noticeable disparities in opioid dispensing among different racial and ethnic groups within California. The findings indicated a correlation of high-risk dispensing indicators with certain demographic and socioeconomic factors. There was a substantial regional variation in opioid dispensing practices, with certain rural areas having higher rates of opioid prescriptions than urban areas. Full article
(This article belongs to the Special Issue Opioid Crisis during the COVID-19 Pandemic)
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