Doctors more likely to prescribe opioids on Covid’s ‘long hauls’, raising fears of addiction

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Covid survivors are at risk of a possible second pandemic, this time of opioid addiction, given the high rate of pain relievers prescribed to these patients, according to health experts.

A new study in Nature has found alarming rates of opioid use among covid survivors with persistent symptoms in Veterans Health Administration facilities. About 10% of covid survivors develop a “long covid”, struggling with health problems that are often debilitating, even six months or more after a diagnosis.

For every 1,000 long-term patients, known as “long-haul” patients, treated at a Department of Veterans Affairs facility, doctors wrote nine more opioid prescriptions than they otherwise would have. , as well as 22 additional prescriptions for benzodiazepines, including Xanax and other addictive pills used to treat anxiety.

Although previous studies have shown that many covid survivors suffer from persistent health problems, the new article is the first to show that they use more addictive drugs, said Dr Ziyad Al-Aly, lead author of the ‘article.

He fears that even a seemingly small increase in the inappropriate use of addictive pain relievers will lead to a resurgence of the prescription opioid crisis, given the large number of covid survivors. More than 3 million of the 31 million Americans infected with covid develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety, and memory problems known as “brain fog.” “.

The new study also found that many patients suffered from severe muscle and bone pain.

The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, chief of research and education at the VA St. Louis Health Care System.

“Doctors are now supposed to avoid prescribing opioids,” said Al-Aly, who has studied more than 73,000 patients in the VA system. When Al-Aly saw the number of opioid prescriptions he said, he thought to himself, “Is this really happening again?”

Doctors must act now, before “it is too late to do something,” Al-Aly said. “We need to act now and make sure people get the care they need. We don’t want this to turn into a suicide crisis or another opioid epidemic. “

As more doctors realize their addictive potential, new prescriptions for opioids have dropped by more than half since 2012. But American doctors are still prescribing many more drugs – which include OxyContin, Vicodin and codeine – than doctors in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.

Some patients who became dependent on prescription pain relievers switched to heroin, either because it was cheaper or because they could no longer get opioids from their doctor. Overdose deaths have increased in recent years as drug dealers have started adding heroin to a strong synthetic opioid called fentanyl.

More than 88,000 Americans died of overdoses in the 12 months ending August 2020, according to the Centers for Disease Control and Prevention. Health experts are now advising doctors to avoid prescribing opioids for long periods of time.

The new study “suggests to me that many clinicians still don’t get it,” Kolodny said. “Many clinicians have the misconception that opioids are suitable for patients with chronic pain.”

Covid hospital patients often receive a lot of medication to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients placed on ventilators, for example, are often sedated to make them more comfortable.

Martin expressed concern about the study’s results, which suggest patients continue to take medication unnecessarily after leaving the hospital.

“I am concerned that patients with covid-19, especially those who are critically and critically ill, will receive a lot of medication during hospitalization, and because they have persistent symptoms, the medications are continued after discharge from the hospital. ‘hospital,’ Martin said.

While some covid patients experience muscle and bone pain for the first time, others say the disease has intensified their pre-existing pain.

Rachael Sunshine Burnett has suffered from chronic back and foot pain for 20 years since an accident in a warehouse where she once worked. But Burnett, who was first diagnosed with covid in April 2020, said the pain quickly worsened 10 times and spread to the area between his shoulders and spine. Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which provides immediate pain relief. She was re-infected with covid in December.

“It has been a horrible and horrible year,” said Burnett, 43, of Coxsackie, New York.

Doctors should recognize that pain can be part of a long covid, Martin said. “We have to find the appropriate non-narcotic treatment for this, just like we do with other forms of chronic pain,” he said.

The CDC recommends a number of opioid alternatives – from physical therapy and biofeedback, to over-the-counter anti-inflammatories, antidepressants, and anti-seizure medications that also relieve nerve pain.

Country also needs a comprehensive strategy to deal with the wave of post-covid complications, Al-Aly said

“Better to be prepared than to be caught off guard years from now, when doctors realize… ‘Oh, we have an opioid resurgence,” Al-Aly said.

Al-Aly noted that his study may not capture the full complexity of the needs of post-covid patients. Although women constitute the majority of long covid patients in most studies, most patients in the VA system are men.

The study of VA patients clearly shows that we are not ready to meet the needs of 3 million Americans with a long covid, ”said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will treat these people effectively.”

Al-Aly said covid survivors could need care for years.

“This is going to be a huge and significant burden on the health care system,” Al-Aly said. “A long covid will reverberate through the healthcare system for years, if not decades, to come.”

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