Doctors are more likely to prescribe opioids to COVID for “long carriers,” which increase fears of addiction

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Editor’s Note: Find the latest news and guidance on COVID-19 in Medscape Coronavirus Resource Center.

Covid survivors are at risk for a separate epidemic of opioid addiction, given the high rate of painkillers being prescribed to these patients, according to health experts.

A new study in Nature found alarmingly high rates of opioid use among covid survivors with persistent symptoms at veterans ’health administration facilities. About 10% of covid survivors develop a “long covid,” which struggles with often disabling health problems even six months or more after diagnosis.

For every 1,000 patients with long-term covides, known as “long carriers,” who were treated at a veterans ’facility, doctors wrote nine more opioid prescriptions than they would have, along with 22 additional benzodiazepine prescriptions, including Xanax and other addictive pills used to treat anxiety.

Although previous studies have found that many covetous survivors experience 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 paper.

He is concerned that even a seemingly small increase in the inappropriate use of addictive pain pills 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 covid-infected Americans 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 presented with significant muscle and bone pain.

Frequent use of opioids was surprising, given concerns about its addictive potential, said Al-Aly, head of VA St. Louis’ research and education service. Louis Health Care System.

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

Doctors must act now, before “it is too late to do anything,” Al-Aly said. “We need to act now and ensure that people get the care they need. We don’t want this to happen in a suicide crisis or another opioid epidemic.”

As more doctors realized its addictive potential, new opioid prescriptions fell, more than half since 2012. But U.S. doctors still prescribe many more drugs (including OxyContin, Vicodin, and codeine) than doctors in other countries, said Dr. Andrew Kolodny, medical director of research on opioid policies at Brandeis University. .

Some patients who became addicted to prescription painkillers switched to heroin, either because it was cheaper or because they could no longer get opioids from their doctors. Overdose deaths increased in recent years when drug traffickers began poking heroin with a potent synthetic opioid called fentanyl.

More than 88,000 Americans died of overdose during the twelve months ending August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.

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

Hospitalized covetous patients often receive many medications 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 usually sedated to make them more comfortable.

Martin said he is concerned about the study’s findings, which suggest that patients continue medications unnecessarily after they leave the hospital.

“I am concerned that patients with covid-19, especially those who are severely and severely ill, receive many medications during hospitalization, and because they have persistent symptoms, medications are continued after hospital discharge,” Martin said. .

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

Rachael Sunshine Burnett has suffered from chronic back and foot pain for twenty years, from an accident at a warehouse where she once worked. But Burnett, who was first diagnosed with a covidi in April 2020, said the pain soon worsened 10 times and spread to the area between his shoulders and spine. Although he was already taking long-acting OxyContin twice a day, his doctor prescribed him an additional opioid called oxycodone, which relieves the pain immediately. It was reinfected with covid in December.

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

Doctors should recognize that pain can be part of a long covidi, Martin said. “We need to find the right non-narcotic treatment for this, as we do with other forms of chronic pain,” he said.

He CDC recommends a number of alternatives to opioids – from physiotherapy to biofeedback, over-the-counter anti-inflammatory drugs, antidepressants, and anti-seizure medications that also relieve nerve pain.

Al-Aly, the country also needs a global strategy to deal with the wave of postcovid complications

“It’s better to be prepared than to be caught on guard in a few years, when the doctors realize …” Oh, we have a resurgence of opioids, “Al-Aly said.

Al-Aly noted that his study may not capture the full complexity of the postcovide patient’s needs. Although women make up the majority of patients with long covides in most studies, the majority of patients in the VA system are men.

The study of patients with VA makes it clear that “we are not prepared to meet the needs of 3 million Americans with long covides,” said Dr. Eric Topol, founder and director of the Scripps Research Translation Institute. “We desperately need an intervention that effectively treats these people.”

Al-Aly said covetous survivors may need attention for years.

“This will place a huge and significant burden on the healthcare system,” Al-Aly said. “The long covidi will impact the health care system for years or even decades.”





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