Intravenous painkillers are running short during the pandemic in part because of the Drug Enforcement Administration’s opioid production restrictions, one of the biggest hospital policy groups in the U.S. said.
The DEA has slashed the amount opioid producers can manufacture over the last couple of years as part of the federal government’s response to the opioid epidemic. It’s made prescription opioids harder for everyone to get, including hospitals.
Shortages caused by the Covid-19 pandemic pushed the DEA to increase the amount of opioids companies can produce this year by 15%, but the agency still lumps more commonly abused tablets together with the injectable versions like fentanyl and morphine that hospitals require.
Unless the agency gives hospitals more access to IV painkillers, hospitals will keep running short of the medications needed to help ventilate coronavirus patients and sedate patients before surgery, Premier Inc. wrote in a Wednesday letter to the DEA. One solution is for the DEA to start tracking those forms of the medications separately as part of its annual quotas to producers, the group suggested.
“Absent adequate supply of injectable opioids, patient care is threatened by canceling or delaying surgical procedures and increasing the risk of medication errors,” the group wrote. “In the case of COVID-19, shortages of these drugs may inhibit a patient from being ventilated.”
The DEA declined to comment on its opioid quota policy or potential changes it might make.
The request puts the federal government in a difficult position as it tries to tackle two crises: drug deaths and drug shortages. It also highlights how Covid-19 is complicating long-standing policy efforts to combat drug addiction.
Opioid Deaths Rising
Premier’s request comes after opioid overdose deaths set a new record in 2019, according to Centers for Disease Control and Prevention data. There were 70,980 overdose deaths reported in 2019, more than the nation’s previous record of 70,699 in 2017. Preliminary data indicates 2020 overdose deaths are on track to be even higher than last year’s.
Drug deaths are now primarily caused by illicit opioids rather than the prescription opioids that initially fueled the epidemic, addiction specialists say. Federal officials also acknowledged in March a bump in deaths caused by stimulants like methamphetamine.
With overdose trends shifting, addiction specialists like Amer Raheemullah caution that slashing opioid availability for hospitals “does not help the opioid epidemic.” Raheemullah is director of the addiction medicine consult service at Stanford Hospital and a clinical consultant at the telehealth service Lucid Lane.
“We’ve had years where opioid prescribing has decreased but opioid overdose deaths have continued to increase” because of “more powerful, illicit opioids like carfentanil,” he said.
For that reason, pharmaceutical companies should meet clinical demands for opioids, he said. But he cautioned against any policy that would encourage someone to switch from a tablet opioid to its IV form without a good medical reason.
“When we deliver opioids through an IV route, it has a quicker onset and quicker rush and quicker reinforcement” he said. That means the chances of getting addicted are higher.
Returning to federal policies put in place on the onset of the opioid epidemic, like access to medication assisted therapy, is one of the best ways to cut back on drug deaths, Raheemullah said. Getting the Covid-19 pandemic under control is also crucial to reverse the overdose trend, he said.
“We’ll see people who were previously doing well in their treatment,” Raheemullah said, “and then starting to struggle due to shelter in place.”