The Prescriptive Opioid Emergency in the Wake of COVID-19

Written September 2020, revised 2026.
Written six months into COVID-19, about a second public-health emergency that did not pause for the first. The specific figures are of their moment; the structural point — that attention is a finite resource and emergencies compete for it — is why watch systems have to hold more than one threat at a time.

A global pandemic does not abate other public health emergencies. With the nation focused on the COVID-19 pandemic, the opioid epidemic remained in full force. In 2020 the American Medical Association (AMA) released an issue brief in which it expressed concern about an increase in opioid-related mortality. National, state and local leaders followed with their own advisories. With resources stretched and national attention focused on the pandemic, State and Local Leaders need to look for solutions that can stem the tide of this disease.

Leveraging key analytics from Prescriptive Drugs Monitoring Programs (PDMP) along with new guidance from the Substance Abuse and Mental Health Services Administration (SAMHSA) can provide law enforcement, mental health professionals, and physicians more flexibility in fighting the fight against prescriptive opioid abuse during the pandemic.

OPIOID ABUSE IN THE WAKE OF COVID-19

The opioid epidemic is one of the largest crises’ to impact the public health sector in national history as it is. In the last five years alone, fatalities related to opioids have increased by more than 20%, with approximately 130 deaths per day in the United States. And, the numbers have steadily continued to rise until just before the pandemic outbreak. The nation-wide public health crisis of opioid addiction saw a substantial increase over the last few decades; contributing to nearly 450,000 overdose-related deaths from 1999–2018. Deaths related to opioid overdose rose steadily through 2018, reaching 47,000 — six times the 1999 figure (CDC)

As COVID-19 has spread across the United States, addiction doctors have feared that the stress, isolation, and financial hardship the pandemic has left in its wake would wreak particular devastation on the roughly half-million Americans with opioid addiction. To underline this fear, Well Being Trust, a public health group, projected that 75,000 Americans would die from suicide and overdose as a result of the pandemic. Richard Jorgensen, MD, the DuPage County coroner, announced, “In the past three weeks, we have had 20 overdose deaths, mainly due to opioids… we do not know if this is due to a change in the makeup of the drugs, drug usage on the streets, or due to current COVID-19-related changes in society”. Dr. Jorgensen has a right to raise awareness, the Illinois Department of Health recorded 315 opioid-related deaths in the county and over 303 overdoses reported in DuPage hospital emergency departments in 2020. These warnings are not isolated to the Midwest. In Shelby County, Tennessee, 391 suspected overdoses were reported to have occurred between April 7 and May 7, resulting in 58 deaths (AMA, COVID-19 Worsening the Opioid Crises). Other surges have been reported in Milwaukee County, Wisconsin, and Franklin County, Ohio. Franklin Counties coroner released a similar statement, “As you may have seen, Friday night to Saturday night our county saw 28 nonfatal overdoses — this is a high number for our county,” Anahi Ortiz, MD, posted May 3 on Facebook. “COVID-19 has shown us the vulnerabilities and deficiencies in our addiction services — in addition, it has increased the mental health needs of this population”.

Outside of isolation, the logistics of addiction treatment have also become more complicated. Issues related to reduced hours of operations for many treatment facilities to unemployment and the connected loss of medical insurance have long sparked concerns that requests for opioid prescriptions and resultant overdoses would spike. Specifically, doctors have argued that the new (post-COVID-19) protocols for telehealth and medication delivery services could result in a sweeping expansion of illicit opioid prescriptions. Additionally, the United Nations Office on Drug and Crime warns of an additional threat: an increase in the use of prescriptive opioids due to providers transitioning to new COVID-19 protocols have resulted in actual drug shortages due to the rate of consumption and limits on pharmaceutical production due to supply chain issues and corporate shutdowns. A shortage in supply has led to the consumption of other harmful, domestically produced substances and an increase in injecting drug use and the sharing of injecting equipment. All of which carry the risk of spreading diseases like HIV/AIDS, hepatitis C, and COVID-19 itself.

PRESCRIPTIVE OPIOID ANALYTICS

Many Local and State agencies have difficulty in integrating data that may be relevant to stemming the tide of illegal opioid prescriptions. This drawback limits lead generation for law enforcement and regulatory bodies and prevents executives from reviewing integrated analytics on Schedule-II to schedule-V narcotics within their jurisdiction. Artificial Intelligence (AI), automated data deconfliction, and Robotic Process Automation (RPA) can help by providing key stakeholders with the tools they need to stem the tide of prescriptive opioid abuse. Namely,

• Law Enforcement and Regulatory Bodies: live investigative tools to help understand where opioid-related incidents are happening and the individuals who may be responsible. Tools that provide the predictive attributes along with investigative tools that allow enforcement and regulatory bodies the ability to leverage the integrated datasets for physician licensing and pharmaceutical investigations.
• Preventative Agencies: Department of Military and Veterans Affairs, Department of Education, and Department of Health and Human Services are in a unique position to apply preventative methodologies to stem the tide of Opioid Abuse. These agencies require tools for targeted education campaigns to improve the public’s understanding of substance use disorders, as well as source evidence-based treatments and apply prevention strategies to support a broader adoption of Assisted Outpatient Treatment and Assertive Community Treatment models.
• Executive: Key stakeholders all analysis, statistics, and measurements on the current State of the Opioid Epidemic, on-going operations, and marketing, and campaign effectiveness in order to derive insight on which regulations and/or legislation may need to be addressed to combat the opioid epidemic.

Additionally, gathering data and analytics can help us better understand the social and clinical trends that could potentially contribute to the opioid crisis is essential. To help facilitate the inclusion of trends on a national level, leaders have to be technologically equipped to integrate with external sources. The FDA is one such example. In 2019, the FDA set out to create a large-scale data warehouse as a first effort to improve its past initiatives to end the opioid epidemic. In a 2018 press release, FDA Commissioner Scott Gottlieb, M.D., stated: “This warehouse can facilitate data analytics, including machine learning algorithms, to help better assess vulnerability points in the population through predictive analytics, identify early trends that may be contributing to the epidemic, and target early regulatory changes to address the changing opioid epidemic.”

One of the most impactful ways data analytics can assist in combatting the misuse of opioids focuses on the behavioral analytics that determines the potential risk factors for a patient to develop a dependency on an opioid prescription. The idea is, that the use of big data will help providers pinpoint what patients are at high risk. Or, as Inside Big Data comments, “Combining medical records with patient behavior and history to determine risk factors using big data tools, is one of the best ways to fight the epidemic.” Data analytics paves a road for accountability and monitoring of how and when opioids are prescribed by providers during the pandemic. Integrated analysis during isolation and quarantine can reduce the potential for prescription abuse and improving the knowledge and decision-making power of providers.

UNDERSTANDING SAMHSA GUIDANCE

Analytics will not win the war on illegal prescriptive opioid alone. In the fight against the national opioid crisis, various governments and organizations have taken many steps toward combatting the misuse of opioids. Over the last two years, the FDA specifically, noted the following initiatives;

• Regulating prescribing measures
• Implementing new policies
• Providing more education and resources to both patients and providers
• Increase in addiction recovery support resources
• R&D in non-addictive pain treatments
• Data analytics, internet monitoring of online opioid sales

The Substance Abuse and Mental Health Services Administration (SAMHSA), as part of the U.S. Department of Health and Human Services, serves to lead public health initiatives to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.SAMHSA stands ready to provide State and Local leaders guidance and resources to assist individuals, providers, communities, and states across the country. This support includes grant funds that can support opioid prevention strategies during the time of COVID and disaster planning handbooks for behavioral health professionals. SAMHSA has provided evidence-based guidance to health professionals which, include inpatient, outpatient, and residential treatment options. SAMHSA also recommends the use of telehealth and/or telephonic services to provide evaluation and treatment of patients. These resources can be used for initial evaluations, including evaluations for consideration of the use of buprenorphine products to treat opioid use disorder. Further, these resources can be used to implement individual or group therapies such as evidence-based interventions, including cognitive behavioral therapy for mental and/or substance use disorders.

What we built from this. Health surveillance is one of DeepWatch’s standing threat vectors, not a mode it switches into. A watch floor that can only follow the emergency currently receiving attention is not situational awareness. Explore DeepWatch.

An earlier version of this essay was published on Medium in September 2020. This version has been revised.