Measuring the Rise of Drug Misuse & Mental Health Challenges Amid the COVID-19 Pandemic

Announcer:
You’re listening to Clinician’s Roundtable on ReachMD, and this episode is sponsored by Quest Diagnostics. Here’s your host, Dr. Charles Turck.

Dr. Turck:
Welcome to Clinician’s Roundtable on ReachMD. I’m Dr. Charles Turck, and joining me to discuss the impact that the COVID-19 pandemic has had on the drug misuse crisis is Dr. Marie Hanna, who’s the Chief of the Division of Regional Anesthesia and Acute Pain Medicine, and an Associate Professor of Anesthesia and Critical Care Medicine at Johns Hopkins University. Dr. Hanna, thanks for being here today.

Dr. Hanna:
Thank you so much, Dr. Turck.

Dr. Turck:
To start us off, Dr. Hanna, would you tell us how the prevalence of drug misuse, specifically non-prescribed fentanyl use, has changed during the COVID-19 pandemic?

Dr. Hanna:
Well, thank you for the question. According to the Centers for Disease Control and Prevention, the CDC, it says with COVID-19 pandemic, annual death was nearly 50 percent higher in 2021 compared to 2019. So around 100,000 people died of drug overdose in 2021. Around an average of every five minutes, one person is dead. And two-thirds of those deaths were related to fentanyl, and other synthetic opioids. In 2021, almost 71,000 fatal overdose deaths from fentanyl, and this is considered 23 percent higher than previous years. I want to mention here, overdose death in adolescents increased dramatically since 2019, during the pandemic. According to the Journal of the American of Medical Association, deadly overdose deaths among adolescents nearly doubled, from around 500 to almost 1,000 in 2020, and with a 20 percent even extra, in 2021.

Dr. Turck:
As a quick follow-up to that, what are the dangers of fentanyl misuse?

Dr. Hanna:
Oh, I’m so happy that you asked this question, because fentanyl, as you know, Dr. Turck, is the most commonly used synthetic opioid. It’s a manmade, so it’s not an actual compound. And it is extremely potent, and it acts exactly on the same receptors in the brain like any other opioid – like morphine and heroine. But two milligrams of fentanyl, it’s been studied, that it can be deadly for 95 percent of the American public. So, take this in consideration: when people use fentanyl, interaction of fentanyl inhaled in the nose or mouth, and absorbed in the mucous membranes, can cause severe adverse reaction.

The potency of fentanyl made it very profitable for dealers, so a little amount can make people high, and add a little bit more amount can make people dead. So, it’s very dangerous because people use it intentionally or unintentionally.

Dr. Turck:
Now with that in mind, let’s explore some factors that might be contributing to this and other substance misuse crises. For instance, patients now have more access to marijuana. What kind of role has access to that, together with alcohol, had on the rising rates of substance abuse?

Dr. Hanna:
So, during the COVID pandemic we’ve seen the rise of fentanyl deaths, but we also saw a big rise in alcohol sales was increased by 55 percent in the United States, and similar increase in Europe. Regarding marijuana, the use of marijuana has increased 40 percent in the last two years, and the last two years was the pandemic, and we have records that New York and Los Angeles are two of the main leading cities consuming marijuana in the world. We have some statistics to show that marijuana has been used for many years; around 48 million people used marijuana in 2019. Now we have up to 55 million. In 2020, 44 percent of college students have tried marijuana, compared to 38 percent in years before. 8 percent of those users are using it every day, and with heavy use. This is very alarming. People don’t understand chronic marijuana users - they’re not going to die like they die from opioids, so the incidence of overdose deaths from marijuana, is not bad. But there is a big association with a big range of negative health consequences, like lung disease, heart disease, psychosis, depression and anxiety, declining cognitive function, memory, poor coordination, time perception. And when they use it at young age, it really disrupts the normal brain development which we see in adolescents. And, if pregnant women use marijuana, it does potentially affect the neural development of the baby or the fetus. Long-term use of marijuana have been linked increasingly to psychosis and schizophrenia. Unfortunately, during the pandemic, a lot of states considered marijuana business as an essential service, so they kept it open, and the online purchase kept going. That’s why we see the big rise in the use of marijuana during the pandemic.

Dr. Turck:
Now, the prevalence of mental health disorders has also risen during the pandemic, so what can you tell us about that potential link?

Dr. Hanna:
If a patient has mental problem and using opioids, he is more likely to overuse or misuse those opioids and harm himself or even causing death. It’s not a surprise to us, but we needed to see it in number. And two years during the pandemic, we looked at reports when people take mental health surveys and tests online. We find there is a 500 percent increase in the number of patients, or of the number of people who will go online and take those tests, compared to 2019. So, 500 percent increase. With those increase, there was 16 percent increase in youth, age 11 to 17 years old. So, the young adult age 11 to 17, have been used this mental health surveys, 16 percent higher than previous years. From all those screens, 76 percent of those who took the mental health, scored positive for moderate to severe symptoms of mental health. This is very alarming, and this is quite an increase from previous years. In regards of psychosis, 300,000 people took the screen survey for psychosis in 2021, with 78 percent scoring moderate to severe, psychotic-like episodes, and again, this is another alarming situation we see. Among the people who took the survey, the question was, what exactly made you in this condition, or makes you have a problem? 63 percent of these patients stated loneliness and isolation. 49 percent, they mentioned past trauma in their life, and 37 percent mentioned a relationship problem. And not to ignore some answers were because of loss of a loved one with the pandemic. Some say it’s financial problems, politics, and some racism was thrown out there as well. Drug overdose death in adolescents have doubled if you compare 2019 to 2020. So, it doubled in 220 compared to 2019, and actually increased 20 percent higher in 2021.

Dr. Turck:
For those just tuning in, you’re listening to Clinician’s Roundtable on ReachMD. I’m Dr. Charles Turck, and speaking with Dr. Marie Hanna about the rise in drug misuse amid the COVID-19 pandemic. So, Dr. Hanna, now that we better understand this issue, let’s look at how we can overcome it. What are some tools and strategies that could help detect drug misuse?

Dr. Hanna:
So, like I mentioned, during the pandemic, we have three major things. We have mental health problems, we have fentanyl that is everywhere, and we have marijuana and alcohol. So, I think to tailor down the problems we’re having, we have to start by having a strategy, because everything starts with mental health, and with the rise of mental health problems, we have to pay attention, and have a strategy how to prevent and how to treat mental health. I think educating the public is very essential, because people still think that “I don’t need a psychiatrist. I don’t need a therapist.” But it is mainly for prevention. And in the same side, we need to really improve the insurance coverage for therapists and psychiatrists. And improve and increase the cognitive behavioral therapy, because these groups help patients a lot.

Moving to the fentanyl and the overdose opioid, we have done already a lot. In regards of opioids, with the PGMP with the Prescription– Monitoring Program, to see patients who are prescribed opioids and the amount of opioid prescribed, and this is very important. The other thing – we have to cut down the supply of fentanyl. Fentanyl still exists a lot in our country, so we need to pay attention to this. Like I mentioned before, it’s a lot of fentanyl coming to our country, through the south border, that it’s overseas by the borders police control. We have 11,000 kilogram of fentanyl seized in the border, which is 134 percent higher than last year. So, we need to pay attention and to cut down the supply of fentanyl.

Dr. Turck:
And as we know, the COVID-19 pandemic has limited many patients’ access to clinics. So, what are some ways we can work around that limitation?

Dr. Hanna:
This is an excellent question, because a few things we’ve done since beginning of the pandemic. So in March 16, 2020, the DEA provided guidance related to the COVID-19 pandemic, and allowing prescribers to see their patient through telemedicine without a prior, in-person exam. And this made a big difference, because now we have patients who need opioids, who are surgical patients, who have pain, who needs opioid or who needs a follow-up, but they cannot make it to the clinic. So now, we can see them through a screen, and we can electronically prescribe opioid, and tailor down and taper down their opioid in a very timely manner, to prevent the easy access to opioids or the misuse of opioids. So, we have a great experience with this at Johns Hopkins, and our clinic. The perioperative pain program was successfully meeting during the pandemic with telemedicine, and we’re able to see more patients, and our results in following up and tapering down opioids and keeping the patients safe was very successful.

This also could be done in mental health, because patients, even if they are locked down, or they cannot see the provider, but they have to talk to them, so through telemedicine, they were able to see their patients therapists and psychiatrists, and group therapy, through Zoom meetings and telemedicine. So, this was a good thing and I think it will continue. Now we do have hybrid. People can go to the clinic or they can do telemedicine, and this is a big advantage.

Dr. Turck:
Now, we’re almost out of time for today, so before we close, do you have any final thoughts you’d like to share, Dr. Hanna?

Dr. Hanna: I think my final thoughts will be we need to say the truth and keep educating the public. We cannot stay silent when mental health is rising. We cannot stay silent when marijuana users are really increasing by day, and same for opioids and fentanyl. So, we have to keep talking. Keep educating the public. Keep  putting rules, and listen to the CDC and listen to the DEA, and then I think education is the key. Continue with telemedicine and providing help for those providers who want to help the patients – providing help to the patients who cannot afford frequent visits and big bills. So, I think this is the key for the future. And focus on the young generation. We’ve seen that the young generation have been the most hit with this pandemic, with mental health, with opioid overdose, and with marijuana overuse.

Dr. Turck:
Well, given the considerable rise of drug misuse and overdoses around the world, I want to thank my guest, Dr. Marie Hanna, for sharing her insights on how we might combat this health crisis. Dr. Hanna, it was great having you on the program today.

Dr. Hanna:
Thank you so much, Dr. Turck.

Announcer:
This episode of Clinician’s Roundtable was sponsored by Quest Diagnostics. To access other episodes in this series, visit ReachMD.com/cliniciansroundtable, where you can Be Part of the Knowledge. Thanks for listening!