Doctors More Likely to Prescribe Opioids to COVID ‘Long Haulers’

With millions of people facing long-COVID, health experts worry about a resurgence of opioid addiction
May 23, 2021 Updated: May 24, 2021

COVID survivors are at risk from a separate epidemic of opioid addiction, given the high rate of painkillers being prescribed to them, according to health experts.

A new study in Nature found alarmingly high rates of opioid use among COVID survivors with lingering symptoms at Veterans Health Administration facilities. About 10 percent of COVID survivors develop “long COVID,” struggling with often disabling health problems six months or longer after a diagnosis.

For every 1,000 long-COVID patients—sometimes referred to as “long haulers”—who were treated at a Veterans Affairs facility, doctors wrote nine more prescriptions for opioids than they would have otherwise, along with 22 additional prescriptions for benzodiazepines, including Xanax and other addictive pills used to treat anxiety.

Although previous studies have found many COVID survivors experience persistent health problems, the Nature article is the first to show they’re using more addictive medications, said Dr. Ziyad Al-Aly, the paper’s lead author.

Al-Aly is concerned that even an apparently small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis, given that there are a large number of COVID survivors. More than 3 million of the 31 million Americans infected with COVID have developed long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety, and memory problems known as “brain fog.”

The new study also found many patients have significant muscle and bone pain.

The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, who also serves as chief of research and education service at the Veteran Affairs St. Louis Health Care System.

“Physicians now are supposed to shy away from prescribing opioids,” said Al-Aly, who studied more than 73,000 patients in the Veteran Affairs system. When he saw the number of opioid prescriptions, he recalled thinking to himself, “Is this really happening all over again?”

Doctors need to act now, before “it’s too late to do something,” Al-Aly said. “We must act now and ensure that people are getting the care they need. We do not want this to balloon into a suicide crisis or another opioid epidemic.”

Since 2012, as more doctors became aware of their addictive potential, new opioid prescriptions fell by more than half. But U.S. doctors still prescribe far more of the drugs—which include OxyContin, Vicodin, and codeine—than physicians in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research 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 obtain opioids from their doctors. Overdose deaths surged in recent years, as drug dealers began spiking heroin with a powerful synthetic opioid called fentanyl.

More than 88,000 Americans died from overdoses during a 12-month span ending in 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 are under the false impression that opioids are appropriate for chronic pain patients.”

Hospitalized COVID 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 said he’s concerned by the study’s findings, which suggest patients are unnecessarily continuing the use of medications after leaving the hospital.

“I worry that COVID-19 patients, especially those who are severely and critically ill, receive a lot of medications during the hospitalization, and because they have persistent symptoms, the medications are continued after hospital discharge,” Martin said.

While some COVID patients are experiencing muscle and bone pain for the first time, others say the illness has intensified their preexisting pain.

Rachael Sunshine Burnett has suffered from chronic pain in her back and feet for 20 years, ever since being involved in an accident at a warehouse where she once worked. But Burnett, who first was diagnosed with COVID in April 2020, said the pain soon became 10 times worse and spread to the area between her shoulders and spine. Although she was already taking long-acting OxyContin twice per day, her doctor prescribed an additional opioid called oxycodone, which relieves pain immediately. She became infected with COVID once again in December.

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

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

The CDC recommends a number of alternatives to opioids—from physical therapy to biofeedback. Over-the-counter anti-inflammatories, antidepressants, and anti-seizure drugs can also relieve nerve pain.

The country also needs an overall strategy to cope with the wave of post-COVID complications, according to Al-Aly.

“It’s better to be prepared than to be caught off guard years from now, when doctors realize … ‘Oh, we have a resurgence in opioids,’” he said.

Al-Aly noted that his study may not capture the full complexity of post-COVID patient needs. Although women make up the majority of long-COVID patients in most studies, most of the patients in the Veteran Affairs system are men.

The study of Veteran Affairs patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long COVID,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”

Al-Aly said COVID survivors may need care for years.

“That’s going to be a huge, significant burden on the health care system,” Al-Aly said. “Long COVID will reverberate in the health system for years or even decades to come.”

Liz Szabo is a senior correspondent focusing on acute care and end-of-life issues for Kaiser Health News, which originally published this article. KHN’s coverage of these topics is supported by The John A. Hartford Foundation, Gordon and Betty Moore Foundation, and The SCAN Foundation.