As the world battles one major crisis, efforts to combat other crises are being put on hold. The COVID-19 pandemic has upended healthcare efforts on several different fronts, including work to mitigate the U.S. opioid crisis.
Lou Kennedy, CEO and owner of Nephron Pharmaceuticals, spoke to Becker's Hospital Review about the factors that drove the opioid epidemic pre-pandemic, how COVID-19 has exacerbated the crisis and what hospitals can do mitigate opioid misuse in the midst of the pandemic.
Editor's note: Responses were lightly edited for length and clarity.
Question: What were the key factors driving the opioid crisis prior to the pandemic?
Lou Kennedy: One of the key factors driving the opioid crisis prior to the pandemic was the over-prescription of pain medications. According to researchers, the number of patients still using opioid-based pain medication one year after being prescribed just a few days of opioid therapy is skyrocketing. One young mother I know was given a 30-day prescription for opioid-based pain medication after her young son had a tonsillectomy. This is wrong.
Q: Has COVID-19 made the crisis worse? How so?
LK: Yes, it has. Closing down the economy has squeezed recovery and rehabilitation centers, just as it has other businesses, leaving those who are battling addiction without the resources they need to fight. In addition to shuttering recovery resources, the loneliness of quarantine has pushed people back toward substance use. Finally, when COVID-19 patients go on ventilators, they have to be sedated with opioid-based medications. We know once patients use opioid-based medication for three days, their receptors are altered — and they are predisposed to addiction.
Q: How has the pandemic affected efforts in place to curb the opioid crisis?
LK: While we have made great progress on opioid addiction over the last few years, COVID-19 has diverted the attention and resources of public health and mental health professionals away from the opioid crisis and focused them on stopping the spread of this deadly virus. It's more important than ever that we focus on both.
Q: What can hospitals do to make sure they are continuing to combat the opioid crisis in the midst of the pandemic? What are some clinical strategies hospitals can use to reduce the risk of opioid misuse by patients?
LK: The first action is to address the prescription writing for opioids, keeping these to a three-to five-day prescription. The second phase is to initiate an 'opioid stewardship management program safe use of opioids in hospitals.' This program is an interdepartmental initiative with representation from anesthesiology and perioperative medicine, nursing, and pharmacy. It recommends a multimodal approach to pain management protocols. These protocols help to decrease the use of opioids and help stop addiction before it starts.
Q: How has the pandemic affected the medication supply chain?
LK: Prior to the pandemic, China had become the world's largest supplier of both the precursor chemicals used to make active pharmaceutical ingredients and the finished active pharmaceutical ingredients. What the pandemic has exposed is that China could intentionally disrupt the drug supply chain to the U.S. Doing so would exacerbate the current drug shortage crisis in the U.S. and increase the cost of drugs. As a result, we should be doing more to encourage the production of active pharmaceutical ingredients and drugs in the U.S.