Public Health Notes
By Catherine Colquitt, MD
This article was originally published in the March/April 2022 issue of the Tarrant County Physician. You can read find the full magazine here.
In response to soaring overdose deaths across the U.S. during the pandemic, the American Medical Association (AMA) Advocacy Resource Center published a brief on Nov. 21, 2021, cataloging increased overdose deaths state-by-state. They decried decreased access to “evidence-based care for substance use disorder, chronic pain, and harm reduction services.”1
The AMA also sent a letter to the U.S. Centers for Disease Control and Prevention urging requirements for health insurers to eliminate barriers to opioid treatment for patients who would benefit from these therapies (think prior authorizations for prescriptions and faxed referrals for specialists). The letter also supported the Biden Administration’s 2022 National Drug Control Strategy, which highlights increased production of medications for substance use disorders, harm reduction strategies (including needle and syringe exchange programs), access to naloxone without prescription, and elimination of health insurer obstacles which prevent persons with chronic pain from accessing pain management.3
In addition, a letter from AMA’s Dr. James Madara, MD, to Regina M. LaBelle, the acting director of the Office of National Drug Control Policy, on July 9, 2021, stated that healthcare inequities and social determinants of health fueling the overdose epidemic and disproportionately affecting the “marginalized and minoritized” must be addressed.2
The National Vital Statistics System recently released its “Provisional Drug Overdose Death Counts” for 2021 for the fifty states and the District of Columbia.4 The total overdoses will likely be revised upwards as case compilations for 2021 are completed and reports verified, but the provisional death toll is staggering. Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021. (Tarrant County data are not yet available for April – December 2021 on the NVSS dashboard.)
Overdose deaths provide one measure of the toll of COVID-19 in the U.S. and expose need for redress of healthcare inequities, access to medication for opiate use disorders, substance use disorder treatment, mental healthcare access, and access to pain management. Another way the impact of COVID-19 is being assessed is through peer-reviewed publications exploring the hidden costs and benefits of conventional in-person (commuter) work versus work from home.
“Over the 12-month period which ended in June 2021, overdose deaths rose from 47,523 to 98,022, and in Tarrant County, our overdose deaths mirror the national trend with 350 overdose deaths for the 12-month period ending March 2021, compared with 185 overdose deaths for the 12-month period ending January 2021.”
The results of such studies are uneven and the responses necessarily somewhat subjective when subjects are questioned regarding their feelings about in-person versus telework; in general, workers viewed telework more favorably when they volunteered for it and when their schedules included a combination of both in-person and telework. When mandatory, some teleworkers experienced increased “work-family conflict” as the lines between work and domestic life blurred during telework. Teleworkers and conventional in-person workers reported variable effects on depression, exhaustion, fatigue, and energy level.5
Using data from the American Time Use Survey, authors asked workers to record in a diary where they worked (whether they commuted or not) and noted that male teleworkers in this study reported lower pain, stress, and tiredness levels, but that there was no difference in these measures among female commuters versus non-commuters.6
In another study based on the American Time Use Survey, the designers compared pain in working-at-home versus conventional workers and found no difference in pain reporting between the two groups. However, working-at-home fathers reported increased stress and working-at-home mothers reported decreased happiness.7
COVID-19 is, at the very least, an engine powering academic inquiry, which may have unexpected future benefits for the way healthcare is delivered and work is done. In the meantime, we must continue the important work of educating, advocating, and caring for our communities.
1. AMA Advocacy Resource Center: Issue brief: Nation’s drug-related overdose and death epidemic continues to worsen, Updated 11/12/2021
2. AMA letter to Regina M. LaBelle, Acting Director of Office of National Drug Control Policy, 7/9/2021
3. AMA letter to the U.S. Centers for Disease Control and Prevention, June 2020
4. National Vital Statistics System Provisional Drug Overdose Death Counts – NVSS dashboard for current data, with final data when available from https://www.cdc.gov/nchc/nvss/mortality_public_use_data.htm
5. Oakman J et al. A rapid review of mental and physical health effects of working at home: how do we optimize health? BMC Public Health (2020) 20:1825
6. Song Y, Gao J. Does telework stress employees out? A study on working at home and subjective well-being for wage/salary workers J Happiness Stud 2019;21(7):2648-68
7. Gimenez-Nadal JI, Molina JA, Velilla J. Work time and well-being for workers at home: evidence from the American Time Use Survey. Int J Manpow 2020; 41(2): 184-206