Causes for Concern Facing Healthcare Systems relating to the Intersection of Opioid Epidemic and COVID-19 Pandemic

by Jean McClurken, LCSW, LAC & Katy Brown, PharmD

Telligen is focused on how the unprecedented COVID-19 pandemic has affected all aspects of healthcare, including the response to the national opioid epidemic. While a lot of our attention in recent months has been focused on COVID-19, we have seen first-hand the intersection it has with the opioid epidemic. organizations like the National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), American Journal of Managed Care (AJMC), the Addiction Treatment Forum, and news outlets like The Washington Post, New York Times and National Public Radio all agree that there is cause for concern.

Causes for Concern

There are three specific causes for concern that are serving to amplify each other:

  • The pandemic has increased the life-and-death stakes caused by the already existing healthcare disparities across racial and socio-economic lines relating to social determinants of health (SDOH) and access to care.
    • Addressing SDOH and healthcare disparities has been an increasing focus for healthcare delivery systems focused on quality improvement for the past few years. But those efforts have only served to identify a concerning baseline of inequity that minority and rural communities are at greater risk for poorer health outcomes, including death, which was established before the pandemic.
  • The national COVID-19 mitigation strategies have had an unintentional negative downstream impact for people dealing with behavioral health concerns like depression, anxiety, and substance use disorders (SUD), most notably opioid use disorder (OUD) especially in rural areas. Minority populations are also being disproportionately affected by COVID adding a layer of disparity to an already vulnerable population.
    • Social distancing is a necessary intervention to fight the COVID-19 pandemic however, creating a level of social isolation has the the opposite impact of evidence-based interventions for treating SUD including OUD.
    • The economic instability created by social distancing and early lock-down is causing ripples of stress and destabilization in the lives of all connected with the healthcare system to various degrees.
    • Regardless of pre-COVID readiness, because of COVID providers have had to quickly switch to telehealth or other ways of adjusting service delivery that has resulted in reduced access to established in-person treatment services for SUD, including OUD.
  • Early data shows that the national opioid crisis is not slowing but escalating.
    • The Overdose Detection Mapping Application Program (ODMAP) has been publishing early data from the first weeks of the pandemic that have been highlighted across news outlets and professional organizations.
    • The most recent data available about prescribing patterns for medical professionals in the US for opioids from 2018 indicates that despite presidential declaration of the opioid crisis as a national emergency in 2017, there continue to be some hot spots. There is potential these prescribing patterns continued through into the COVID pandemic in 2020 though it’s too early to tell for sure.

Potential Opportunities

Telligen has been involved in telehealth through our work launching our first Project ECHO series in 2019 for provider-based collaboration, and in using it for clinical healthcare assessments with individuals in their communities.

We will be tracking and following data closely to be aware of trends as they emerge and respond accordingly. Just as correlation can be observed in real time, causation benefits from hindsight and evaluation of all factors. Though we are quick to recognize trends we want to participate further in the research of understanding areas for causality when addressing the intersection of the current coronavirus pandemic and the existing national opioid epidemic.

Jean McClurken, LCSW, LAC has been a practicing behavioral health clinician in the field of addiction treatment for over 10 years focused on diagnostic evaluations, treatment planning, and health information management. She has been supporting efforts at Telligen for the past four years relating to improving systems of healthcare delivery, addressing inequities, and promoting behavioral health integration. Addressing the opioid epidemic through improving access to substance use treatment and broadening awareness of pain management techniques as alternatives to opioid prescribing is a personal and professional goal.

Katy Brown, PharmD is a Senior Clinical Pharmacy Program Manager at Telligen and oversees community-based quality improvement initiatives for the Quality Innovation Network – Quality Improvement Organization (QIN-QIO). She is a medication safety task lead and has worked with stakeholders since 2014, in addition to being sought by CMS as an opioid subject matter expert for her key role in successful opioid quality improvement projects.