According to a report from Millennium Health, a laboratory providing medication monitoring and drug testing services, narcotic and other illegal substance abuse has been on the rise in the United States since the COVID-19 pandemic was declared a national emergency. A cross-sectional analysis of 500,000 urine drug testing results from patient specimens around the country, collected between January 1 and May 31, was analyzed to assess for changes in illegal substance use. The specimens of patients with a known prescription for fentanyl, cocaine, or methamphetamine were excluded from the analysis. The study found that "the adjusted positivity rate changes nationally were: 31.96% for non-prescribed fentanyl, 19.96% for methamphetamine, 10.06% for cocaine, and 12.53% for heroin" (heroin was not statistically significant). (See the full report at https://resource.millenniumhealth.com/signalsreportCOVID?utm_source=pressrelease.)

The increase in nonprescription fentanyl use can be traced to its presence in illegal opioids and is likely an underlying contributing factor in opioid-related deaths since the start of the pandemic. To help decrease deaths from opioid overdose, the Food and Drug Administration (FDA) is urging health care professionals to discuss the use of the opioid receptor antagonist naloxone whenever an opioid is prescribed or when patients are treated for an opioid use disorder. Prescribing naloxone should also be considered if a patient is at higher risk for respiratory depression from other concurrently prescribed drugs, such as benzodiazepines or other central nervous system depressants, or if there are household members, such as children, who would be at risk for accidental ingestion or overdose. Patients at high risk for opioid overdose, such as those with a current or past diagnosis of opioid use disorder or a previous opioid overdose, should also be considered candidates for naloxone prescription.

The FDA is also revising the labeling of all opioid and opioid use disorder medications to include language that encourages coprescription of naloxone. The accompanying patient medication guides will also be updated to include information about naloxone.

Nurses should teach patients, families, and caregivers how to recognize respiratory depression and how to administer naloxone. Naloxone can be safely administered to anyone in any age group who may be experiencing respiratory depression from opioids. Naloxone forms a temporary attachment to opioid receptors, blocking opioids from attaching and thereby reversing their effects. Access to naloxone differs throughout the country, with some states requiring a prescription and others not. (To check individual state policies, go to http://www.usa.gov/state-health.) Nurses can also help establish and participate in interdisciplinary teams within a health care setting to help set policies related to naloxone promotion.

To read the FDA Drug Safety Communication on naloxone and opioids, go to http://www.fda.gov/drugs/drug-safety-and-availability/fda-recommends-health-care.