17 - The Effect of Covid-19 on the Opioid Epidemic: A retrospective review investigating the changes in opioid consumption in chronic pain patients unable to undergo their interventional pain procedure during the Covid-19 pandemic

¹State University of New York Downstate Medical Center, Brooklyn, NY, USA. ²NYC Health + Hospitals/Kings County Hospital Center, Brooklyn, NY, USA

Purpose
The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled. Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by improving access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Some of these policies include allowing all “authorized practitioners” to prescribe controlled substances via telemedicine without first conducting an in-person examination, and removing existing barriers for patients, which includes dose, quantity, refill restrictions on controlled substances. In addition, FDA has advised patients stating the use of NSAIDs could worsen coronavirus disease.
Given the cancellation of elective interventional pain management procedures, relaxed regulations on controlled substances, and cautioned use of NSAIDs during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time. However, to my understanding, there are no reports measuring the rate of opioid prescriptions during the pandemic although there has been numerous reports of increased rates of opioid-overdose related cases when compared to previous years.
Our study will focus on the change in opioid consumption in chronic pain patients who were unable to undergo their interventional pain procedure during the Covid-19 pandemic. By demonstrating whether or not there has been a significant increase in opioid consumption in this patient population, we can justify the efficacy of these procedures and the necessity of these elective procedures to be allowed to be performed during future pandemics.
Methods
Our study will take place at King’s County Hospital Center. It will be a retrospective study looking into the medical charts of chronic pain patients who had a scheduled interventional pain procedure to be performed in the OR, from March 1, 2020 to May 30, 2020. EPIC and QuadraMed are the EMR systems that will be used to collect data. Subjects will be classified into groups based on their cancelled interventional pain procedure. For each patient, the number of opioid(s), frequency, dose, and duration of each opioid prescribed will be obtained from the visits just prior and after the notification of the cancelled procedure. The secondary outcome will determine if there are any co-variates (age, gender, race/ethnicity, and number of procedures received in the past) associated with an increase in opioid consumption.
Results
This study anticipates including a total of about 100 subjects. These subjects will be further divided into their respective planned interventional pain procedures including: epidural steroid injections, facet joint injections, trigger point injections, sympathetic blocks, and radiofrequency nerve ablations. In each group, the change in opioid consumption will be quantified by calculating the change in MME. Data will be further stratified by covariates.
Conclusions
If the results do show a statistically significant increase in opioid consumption with the cancellation of interventional pain procedures, then this may justify that these procedures should be allowed to be performed during a future pandemic and to think twice before canceling all elective procedures.