In the past 20 years, the opioid epidemic has washed over the country in waves. Waves caused by Oxycontin, over-prescribing prescription opioids, switching from prescription drugs to heroin & synthetic opioids. Three waves are tied to different forms of opioids but the fourth wave was caused by the widespread use of other illicit drugs with opioids or poly-substance use.

As the nation deals with COVID-19, there is grave concern that synthetic opioids are now available in larger supply due to the reduced heroin stream cause by border closures and travel restrictions driven by COVID-19. People will substitute drugs they’re less familiar with which may be many times stronger making dosing less reliable and potentially fatal. Overdoses go up, as supply goes down and during shortfalls. COVID-19 may usher in a fifth wave of the opioid crisis.

To mitigate the impact of synthetic opioids during COVID-19, the AMA released new policy recommendations to help patients with OUD including support for harm-reduction efforts. The DEA also developed new guidelines that allow practitioners to prescribe buprenorphine or methadone to OUD patients via telemedicine.