An estimated one in five Americans suffer from chronic pain, and more than 40 people die every day from prescription opioid overdoses. But due to COVID-19 shutdowns, many people trying to manage their pain and addiction have lost their support programs.
Professor Lewis S. Nelson, chair of Emergency Medicine at Rutgers New Jersey Medical School, recently published a commentary in the journal Jama Network Open emphasizing the need for rational and compassionate pain management while calling for an expansion of support to help patients overcome the stigma of the disease of addiction. He discusses how patients can manage the disease during the coronavirus crisis.
What health challenges do chronic pain sufferers and people recovering from addiction face during this period of social distancing?
The main concerns are the lack of availability of opioids and to some extent, other pain medications and medications needed for addiction treatment. The abrupt reduction or absence of opioid medications, whether used for pain or opioid use disorder (methadone and buprenorphine), leads to an uncomfortable withdrawal syndrome. This in turn, can lead to poor decision-making and risk-taking by patients, which can have long term consequences.
How are doctors prepping their high risks patients on managing chronic pain and opioid addiction during this self-isolation period?
States regulate pain medications and the federal government controls opioid use disorder medications (methadone and buprenorphine). Both regulatory systems have typically relaxed their normally tight rules to enhance access, such as allowing for more extended prescription durations and the use of telemedicine to evaluate patients without a direct visit or physical examination.
Physicians are communicating the potential for shortages and the need to have clear communication channels and alternative strategies should necessary medications for pain or addiction not be easily available.
Should people be concerned about medication shortages during the current crisis?
Due to production and importation concerns, there is the potential for all medications to be challenging to obtain. Many states have changed prescribing regulations for certain critical medications, such as pain medications and medications for addiction treatment to prevent shortages and ease getting the drug. Pharmacy stocks have generally been good for these medications at this time, but anxiety and fear often lead to overprescribing and hoarding, with significant personal and public health downstream effects.
As an emergency physician, are you worried about people hoarding certain drugs due to the COVID-19 crisis?
There are already shortages of certain medications due to higher than normal needs. Outpatients do not use most of these medications, so the impact will be minimal. Certainly, chloroquine and hydroxychloroquine have been highly utilized and sequestered, often inappropriately, leading to various state regulations to prevent shortages for people who need the medications for non-COVID-19 indications.
What tools or services are available to help people cope with chronic pain or drug addiction during this pandemic?
For patients on opioids for pain, they need to talk with their prescribers to assure the ability to obtain sufficient opioid pain medication. Alternatively, this may be an opportunity to enter a dose tapering regimen to safely reduce their opioid requirements or trial alternative treatments for their pain. For patients in opioid use disorder treatment, they should similarly talk with their programs about obtaining medication, tapering, or other non-medication based alternatives.