The Opioid Epidemic Within the COVID-19 Pandemic: Drug Testing in 2020

Popul Health Manag. 2021 Feb;24(S1):S43-S51. doi: 10.1089/pop.2020.0230. Epub 2020 Oct 8.


The convergence of the opioid epidemic and the coronavirus disease 2019 (COVID-19) pandemic has created new health care challenges. The authors analyzed changes in clinical drug testing patterns and results at a national clinical laboratory, comparing data obtained before and during the pandemic. Testing for prescription and illicit drugs declined rapidly during the pandemic, with weekly test volumes falling by approximately 70% from the baseline period to the trough (the week beginning March 29) before rising in subsequent weeks. Among individuals tested, positivity increased by 35% for non-prescribed fentanyl and 44% for heroin during the pandemic. Positivity for non-prescribed fentanyl increased significantly among patients positive for other drugs: by 89% for specimens positive for amphetamines; 48% for benzodiazepines; 34% for cocaine; and 39% for opiates (P < 0.01 for all comparisons). These findings suggest significant increases in dangerous drug combinations. Positivity for non-prescribed use of many other drugs remained consistent or declined for some drugs, relative to pre-pandemic patterns. Models adjusting for potential confounding variables, including medication-assisted treatment and treatment at a substance use disorder facility indicated that the risk for non-prescribed fentanyl positivity rose by more than 50% during the pandemic. In summary, these findings demonstrate decreased drug testing overall, with increased positivity for high-risk drugs and dangerous drug combinations. The convergence of the drug abuse epidemic and COVID-19 pandemic has led to an increased need for health care and public health resources dedicated to supporting vulnerable patients and addressing the underlying causes of these disturbing trends.

Keywords: COVID-19; SARS-CoV-2; clinical drug testing; fentanyl; opioid; substance use disorder.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Analgesics, Opioid / urine
  • COVID-19*
  • Female
  • Fentanyl / urine
  • Humans
  • Male
  • Middle Aged
  • Opioid Epidemic / statistics & numerical data*
  • Opioid-Related Disorders* / diagnosis
  • Opioid-Related Disorders* / epidemiology
  • Pandemics
  • SARS-CoV-2
  • Substance Abuse Detection / statistics & numerical data*
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology
  • Young Adult


  • Analgesics, Opioid
  • Fentanyl