Covid 19 and America's Drug Crisis

Inaction May Force us to Relive the Past

           The twenty-four-hour news cycle has become nothing more than non-stop Covid 19 Virus news stations. Add the print media, social media, and blogs around the country, and one could easily forget things such as a pending presidential election, world terrorism, hunger, and climate change. While the coverage of all these crises will no doubt resume after Covid 19 passes, these and others like them do not face the prospect of becoming worse in a short period like the nation’s drug crisis. While much has been said about the toll taken on those currently in recovery, little attention has been given to the drug crisis itself.  

          Just before the pandemic, it appeared through many of the reports and statistics that prescription drug overdoses were continuing their decline in most areas of the country. While there are numerous reasons for the decrease in prescription drug use and overdoses, one reason stands out among all. The creation of prescription drug monitoring programs (PDMP) in states nationwide which enabled states to better monitor the prescribing patterns as well as the shopping patterns of drug seekers. The ability to flag doctor shopping and sanction over-prescribing doctors, along with pursuing criminal charges against those blatantly selling, have significantly decreased prescription drug abuse.

          The big question is, will this decline continue, or will Covid 19 fuel the dwindling fire of abuse that plagued the nation for a decade? With most states overburdened with Covid, and forced to allocate every available resource toward it, who will be the gatekeeper for the states PDMP’s? Make no mistake, drug abusers and dealers are always on the lookout for weaknesses in the system that provides them with an opening to obtain drugs and Covid might just be that opening.

          Recently, the media and our own federal government have been lauding the use of telemedicine during this period of social isolation and distancing. This is the same government that before the crisis condemned many of those who practiced and placed strict rules in effect that required face to face visits for those prescribing controlled substances. While this rule was to prevent that doc-in-a-box, online pain clinic which were nothing more than pill mills from selling their wares, what about those who require these meds to maintain an acceptable quality of life? People suffering from chronic pain, pain as a result of diabetic neuropathy, sickle cell, fibromyalgia, and others are caught between a regulation meant to deter drug abuse and a new initiative to keep the population safe from Covid.

          The next six to nine months may be a game-changer in the United States. If unchecked, we could see a resurgence in prescription drug abuse as we did a decade ago. This resurgence could result in a number of factors that could slip through the cracks as states continue to deal with the health issues from Covid. For example, many of the experts heard on a non-stop basis in both the mainstream and social media are offering advice on dealing with the stress and anxiety od Covid. While one cannot argue the fact that most of us have experienced this, some are seeking help from doctors who are prescribing anxiety drugs like Xanax, a benzodiazepine that is one of the most abused drugs today. This class of drug in many ways presents problems which go far beyond those associated with opioids.

          Benzodiazepine addiction requires strict medical supervision to successfully detox a patient in most situations. As a result, many treatment centers are not equipped to treat them. Many find themselves addicted to opioids as unscrupulous dealers, unable to get pharmaceutical Xanax, resort to selling bootleg pills containing fentanyl rather than the active product ingredient (API), alprazolam. The results can be devastating, as many of the benzodiazepine users are not opioid-tolerant, and when supplied, these bootleg drugs usually overdose and often die.  

          While the increase in the benzodiazepine class might be considered an unexpected result of Covid 19, it is not the only one. Some doctors will see this as an opening to engage in unethical practice as they hide behind the new acceptance of telemedicine. With guidelines for the practice of telemedicine vague or non-existent, the leeway allowed may embolden many of those looking to capitalize on such lax regulations. Once Covid has passed, will there be anyone willing to convict some country doctor for practicing a form of medicine encouraged by the government and the media during this crisis?

           During this time of crisis, the state and federal government need to multi-task. They need to remember that Covid 19 will pass, but our nation’s drug problems have not and in all likelihood will ever. As a result, the PDMP’s created as a result of the prescription drug crisis cannot be ignored or overlooked, especially now. Both the states and the Federal government also need to establish strict guidelines for the practice of telemedicine. Guidelines mean one state having no regulations and others having strict regulations. We have already witnessed firsthand what results from that. We saw the caravans up and down the I-95 corridor from the northeast and rustbelt states, to states like Florida, where pill mills flourished. The same will happen if telemedicine rules are not, at the very least subject to some federal oversight.

           Please make no mistake; there are currently people taking advantage of Covid 19 as they do with any crisis. The question however is, can states handle more than one crisis at a time? Can the federal government tout the benefits of telemedicine while at the same time remembering their restrictions placed on it previously? Can the states laud their PDMP's while stripping it of the resources desperately needed in the name of Covid 19?

           It’s not the time for mixed messages or complacency. The opioid crisis has killed far more than Covid 19 has or probably ever will worldwide. How we proceed or instead if we proceed, might determine if we relive the past decade of prescription drug abuse once again. If the problem goes ignored, we will be hard pressed to blame the pharmaceutical companies. This time, the blame will fall squarely on those who were unable to handle more than one crisis at a time.

Dr. M. Haskins has investigated pharmaceutical fraud and diversion for over 20 years. He provides consulting services to medical practices and pharmaceutical organizations and is a frequent lecturer on performance enhancing drugs among young people.

He can be reached at [email protected]