Background & Aims

During the early stage of the COVID-19 pandemic, the individual perceived risk was found to be associated with information obtained from official social media. Collective protective measures, such as lockdowns and cancellations of public events also directly and indirectly shaped individual protective behaviors. People avoided hospitals or delayed even necessary treatments to minimize the chance of infection. Meanwhile, there were warnings and reports highlighted the epidemic of opioid overuse during pandemic. Psychological impacts caused by the disease itself, lockdowns, inaccessibility to adequate pain medications, or the fear can be associated with the use of opioids by patients with chronic pain. However, Taiwan had a very low infection rate at that time. Therefore the actual threat was far less than the perceived threats. This study aimed to investigate the use of injectable opioids in chronic pain in this place where perceived threats was larger than actual threats.

Methods

This was a single center, ecological study of treatment-seeking behaviors in patients with chronic non-cancer pain during the COVID-19 pandemic in Taiwan, a place where the perceived threat from COVID-19 was greater than the actual threat.
Data on the emergency department (ED) visits of patients with chronic non-cancer pain was collected between 2018 and 2020. The monthly volume of ED visits with administration of injectable opioids for pain control was recorded. Perceived risk was demonstrated with the media coverage on pandemic related reports. Media contents were collected from six major newspaper sources in Taiwan. This study searched for the terms of pandemic, virus, infected/infection, vaccine, and symptoms from news captions. References unrelated to COVID-19 were dropped. Pearson correlation was used to examine the associations between the number of times pandemic-related keywords appeared in mainstream media and the number of visits to ED for injectable opioids.

Results

The trend of opioids injections for pain control in ED shifted at the beginning of the pandemic. There was an increase in the ED visit volume for injectable opioids during that stage. In the correlation analysis, opioid injection volume was shown to be positively correlated with media appearances of pandemic-related reports.

Conclusions

The present study investigated the number of pain patients seeking injectable opioids from ED before and during the early stages of the COVID-19 pandemic. In agreement with reported studies, social aspects of the pandemic, such as public media, systemic hygiene policies, and the collective fear of the virus, had impacts individuals on psychological level in the chronic pain population. However, unlike previous studies, this observational cohort study was conducted in a place where the actual threats from the pandemic were far lower than in the rest of the world. Even in such a place, uncertainties of the pandemic and pain still caused observable treatment-seeking behavior changes in this population. We found that Individuals on long-term opioid therapy for pain management visited the ED more frequently (for injectable opioids) when they first encountered this unknown threat from COVID-19.

References

Bhambhvani, H. P., Rodrigues, A. J., Yu, J. S., Car, J. B. 2nd, & Gephart, M. H. (2021). Hospital volumes of 5 medical emergencies in the COVID-19 pandemic in 2 US medical centers. JAMA Internal Medicine, 181(2), 272–274.

Czeisler, M., Marynak, K., Clarke, K., Salah, Z., Shakya, I., Thierry, J. M., Ali, N., McMillan, H., Wiley, J. F., Weaver, M. D., Czeisler, C. A., Rajaratnam, S. M. W., & Howard, M. E. (2020). Delay or avoidance of medical care because of COVID-19–related concerns: United States, June 2020. MMWR Morbidity and Mortality Weekly Report, 69(36), 1250–1257.
Gao, W., Sanna, M., Huang, G., Hefler, M., Tsai, M.-K., & Wen, C.-P. (2021). Examining population health during the COVID-19 pandemic: All-cause, pneumonia and influenza, and road traffic deaths in Taiwan. Annals of Internal Medicine, 174(6), 880–882.

Ghose, R., Forati, A. M., & Mantsch, J. R. (2022). Impact of the COVID-19 pandemic on opioid overdose deaths: A spatiotemporal analysis. Journal of Urban health : Bulletin of the New York Academy of Medicine, 99(2), 316–327. https://doi.org/10.1007/s11524-022-00610-0

Ng, T.-C., Cheng, H.-Y., Chang, H.-H., Liu, C.-C., Yang, C.-C., Jian, S.-W., Liu, D.-P., Cohen, T., & Lin, H.-H. (2021). Comparison of estimated effectiveness of case-based and population-based interventions on COVID-19 containment in Taiwan. JAMA Internal Medicine, 181(7), 913–921.

Wu, C.-H., Chou, Y.-C., Lin, F.-H., Hsieh, C.-J., Wu, D.-C., Peng, C.-K., & Yu, C.-P. (2021). Epidemiological features of domestic and imported cases with COVID-19 between January 2020 and March 2021 in Taiwan. Medicine, 100(39), e27360.

Presenting Author

Yo-Lin Lin

Poster Authors

Yo-Lin Lin

MD

National Chung Hsin University; Chung Shan Medical University Hospital

Lead Author

LING JUN LIU

Changhua Christian Hospital

Lead Author

Topics

  • Treatment/Management: Pharmacology: Opioid