What Happens When the Opioid Crisis Meets the Coronavirus Crisis?

Besides the difficulty of treating the overwhelming number of patients afflicted by the disease, the pandemic is making some social problems even worse. One example is how our country’s ongoing crisis of opioid overuse and addiction complicates the fight against COVID-19 – in some surprising ways.

Opioid Users Face More Negative COVID-19-Related Outcomes

Individuals with lung disease and respiratory issues, cardiac problems, cancer, diabetes, and severe underlying health conditions seem to be at higher risk for developing serious COVID-19 complications. According to the National Institute on Drug Abuse, because the coronavirus attacks the lungs, people with a history of opioid use disorder (OUD) or who use large doses of opioids may be especially vulnerable. One reason is this population is more likely to smoke or vape tobacco, both of which increase the risk of respiratory illnesses like chronic obstructive pulmonary disease (COPD) and other respiratory disorders.

Another contributor to the elevated risk is the effect opioids have on the respiratory and pulmonary systems. Opioids act in the brainstem to slow breathing, which may cause a harmful decrease in blood oxygen, known as hypoxemia. Sustained hypoxemia can be especially damaging to the brain. Like chronic respiratory damage, potentially permanent lung damage from COVID-19 may lead to a higher number of deaths among ongoing opioid users. Pain sufferers able to recover from COVID-19 may have to alter their post-recovery pain management regiments to account for this possible danger.

Shortages of Opioids Threaten All Critical Patients

An even more unexpected consequence of the coronavirus pandemic is a growing shortage of many opioids. Approximately five years ago, in response to rapidly escalating numbers of drug and opioid-related deaths, the federal government began a multi-pronged attack on the opioid crisis. One strategy involved tightening supply limits for a range of opioid medications.

Since then, the Drug Enforcement Administration has reduced production caps – the maximum amount a manufacturer could legally produce – for many widely-used opioids, including fentanyl, morphine, and hydromorphone. Although these substances have significant potential for abuse, they offer important medical applications in treating COVID-19. Fentanyl, for example, is commonly used to sedate patients on mechanical ventilators.

Other recent disruptions and disasters have taken a toll on the drug supply chain. When Hurricane Maria devastated Puerto Rico in 2017, nearly all of the 50 pharmaceutical manufacturing plants on the island were affected, stopping or slowing production on many drugs and medical supplies.

Medical facilities are now running short on opioids and other vital drugs as patients suffering from COVID-19 flood emergency rooms and intensive care units. The federal government has relaxed limits on production to try and increase supply, but demand is rising at a rate that outpaces production. As the pandemic rages on, medical professionals, pharmaceutical companies, and the federal government continue to struggle to get these critical supplies to the places and patients that need them.