May 18, 2021

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Opioids for COVID-19 “long-haul transporters” raise addiction fears

Opioids for COVID-19 "long-haul transporters" raise addiction fears

Survivors of COVID-19 are at risk of a possible second opioid addiction pandemic, given the high rate of pain relievers prescribed to these patients, health experts say.

TO new study in Nature found alarming rates of opioid use among COVID-19 survivors with persistent symptoms at Veterans Health Administration facilities. About 10% of COVID-19 survivors develop a mysterious condition known as COVID along, grappling with often crippling health problems even six months or more after a diagnosis.

For every 1,000 long-standing COVID patients who were treated at a veterans affairs facility, doctors wrote nine more prescriptions for opioids than they otherwise would. They also wrote 22 additional prescriptions for benzodiazepines, which include Xanax and other addictive pills used to treat anxiety.

Although previous studies have found that many COVID-19 survivors – also known as long-distance transporters – have persistent health problems, the new study is the first to show they are using more addictive drugs, said Dr. Ziyad Al. -Aly, the lead author.

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He is concerned that even a seemingly small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis given the large number of COVID-19 survivors. More than 3 million of the country’s 31 million survivors develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety, and memory problems known as brain fog.

The new study also found that many patients have significant muscle and bone pain.

Frequent use of opioids was surprising given concerns about their addictive potential, said Al-Aly, head of research and education at the VA St. Louis Health Care System.

“Doctors should now avoid prescribing opioids,” he said.

Al-Aly studied more than 73,000 patients in the VA system. When he saw the number of opioid prescriptions, he said, he thought, “Is this really happening again?”

Doctors must act before “it’s too late to do anything,” Al-Aly said. “We don’t want this to turn into a suicide crisis or another opioid epidemic.”

As more doctors have become aware of their addictive potential, new opioid prescriptions have declined more than half since 2012. But US doctors still prescribe far more drugs – which include OxyContin, Vicodin and codeine – than doctors in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.

Some patients who became addicted to prescribed pain relievers switched to heroin, either because it was cheaper or because they could no longer get opioids from their doctors. Overdose deaths have increased in recent years as drug dealers have begun adding the powerful synthetic opioid fentanyl to heroin.

More than 88,000 Americans died overdose during the 12 months ending in August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.

The new study “suggests to me that many doctors still don’t understand this,” Kolodny said. “Many doctors have the false impression that opioids are appropriate for patients with chronic pain.”

Hospitalized COVID-19 patients often receive many medications to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients undergoing ventilators, for example, are often sedated to make them more comfortable.

Martin said he was concerned about the results of the study, which suggest patients are unnecessarily continuing their medications after leaving the hospital.

“I fear that COVID-19 patients, especially those who are severely and critically ill, receive many medications while in hospital, and because they have persistent symptoms, the medications are continued after discharge from the hospital,” he said.

While some COVID-19 patients are experiencing muscle and bone pain for the first time, others say the disease has intensified their pre-existing pain.

Rachael Sunshine Burnett has suffered from chronic back and foot pain for 20 years, ever since she had an accident in a warehouse where she once worked. But Burnett, who was first diagnosed with COVID-19 in April 2020, said the pain soon became 10 times worse and spread to the area between the shoulders and spine.

Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which immediately relieves the pain. She was reinfected with COVID-19 in December.

“It’s been a horrible, horrible year,” said Burnett, 43, of Coxsackie, NY.

Doctors should recognize that pain may be a part of the long-standing COVID, Martin said. “We need to find the proper non-narcotic treatment for this, just like we do with other forms of chronic pain,” he said.

You Center for Disease Prevention and Control recommends a number of alternatives to opioids, including physical therapy, biofeedback, over-the-counter anti-inflammatory drugs, antidepressants, and antiepileptic drugs that also relieve nerve pain.

The country also needs an overall strategy to cope with the wave of post-COVID-19 complications, Al-Aly said.

“It’s better to be prepared than to be caught off guard years from now when doctors realize … ‘Oh, we have a resurgence of opioids,'” Al-Aly said.

Al-Aly noted that his study may not capture the full complexity of survivors’ needs. Although women make up the majority of long-term COVID patients in most studies, the majority of patients in the VA system are men.

The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long COVID,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”

Al-Aly said COVID-19 survivors may need treatment for years.

“This will be a huge and significant burden on the healthcare system,” Al-Aly said. “The long COVID will reverberate in the healthcare system for years or even decades to come.”

This article was produced by Kaiser Health News (KHN), a national newsroom that provides in-depth coverage of health issues and which is one of the three major operational programs a Kaiser Family Foundation. KHN is the publisher of California Healthline, an editorially independent service of California Health Care Foundation.


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