Managing the Opioid Epidemic During COVID-19

Quality Corner July 16, 2020

The Opioid Epidemic has significantly impacted the lives of people around the world and continues to do so today during the COVID-19 pandemic. According to the Centers for Disease Control and Prevention (CDC), in 2018 in the United States, overdose deaths were four times higher than just 19 years earlier in 1999.¹ While overdose deaths decreased by 4% from 2017 to 2018, there were still 68,000 overdose deaths in 2018, with 70% being related to opioid use.¹

Although the novel coronavirus pandemic (COVID-19) has been at the forefront of the media recently, opioid overdose deaths are continuing to claim the lives of an average of 128 Americans daily.¹ These two public health crises are occurring simultaneously, COVID-19 and the Opioid Epidemic. Recent studies are emphasizing the connection between the COVID-19 pandemic and the potential larger impact on opioid related overdose deaths.²

While the Opioid Epidemic and COVID-19 seem to be isolated, recent articles suggest conditions created due to COVID-19 including social distancing, altered social interactions, and economic instability have led to increased opioid overdose deaths.² Social distancing has completely altered daily interactions to allow for virus transmission reduction, but social distancing has also led to profound impacts on individuals with mental illness and substance use disorder.^2,3,4 A recent publication by the American Medical Association (AMA) highlights reports of increases in opioid related overdose deaths in 38 American states, with a particular focus on fentanyl and fentanyl analogues.⁵

Pharmacists have been on the front lines of the COVID-19 pandemic, continuing to provide care to patients. As accessible and knowledgeable health care providers, pharmacists are in an optimal position to have an impact on the two public health crises occurring, the Opioid Epidemic and the COVID-19 pandemic. Community pharmacists can take action to combat opioid related deaths during the COVID-19 pandemic by: [pullquote]Recent studies are emphasizing the connection between the COVID-19 pandemic and the potential larger impact on opioid related overdose deaths. [/pullquote]

Recommending or dispensing naloxone to patients who are prescribed greater than or equal to 50 morphine milliequivalents (MME) to reduce the risk of opioid related overdose death.⁶ Click here for more information about standing orders for naloxone distribution by state.⁷
Educating patients about the risk of opioids, especially if the patient is taking greater than 90 MME. Greater than or equal to 50 MME per day can double the risk of opioid related overdose.⁶ Click here for more information about quality measures related to opioids at high doses. ⁸
Identifying drug-drug interactions that may lead to increased risk of opioid related overdose deaths including but not limited to benzodiazepines such as alprazolam and diazepam and other central nervous system (CNS) depressants including barbiturates and non-benzodiazepine sedative hypnotics such as zolpidem and eszopiclone.⁹ Click here for more information about quality measures related to opioids and high risk medications⁸.
Working with prescribers to ensure that initial opioid prescriptions include the lowest effective dose with an appropriate day supply.

Community pharmacists work daily to provide care to patients by dispensing and optimizing medication regimens. During the coinciding public health crises, COVID-19 and the Opioid Epidemic, it is important for pharmacists to utilize clinical expertise to educate patients and work with other providers to save the lives of patients who may be at increased risk of opioid related overdose deaths. During this critical time, pharmacists can combat both the COVID-19 pandemic and the Opioid Epidemic by saving lives, one patient at a time.

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