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As COVID continued and the opioid epidemic worsened, 3 key health trends emerged in 2021

The persistence of the COVID-19 pandemic throughout 2021 worsened the ongoing opioid epidemic, bringing the deaths from drug overdose to an all-time high. To provide healthcare professionals with the tools they need to keep their patients safe in these unprecedented times, Quest Diagnostics joined with Partnership to End Addiction to examine the factors that contributed to this unprecedented increase, surveying physicians to understand better the barriers they face in their ability to monitor and intervene with their patients at risk for drug misuse.

Three of the key findings emerging in the report are:

1. More than many other groups, physicians recognize that the pandemic has intensified the misuse of drugs, with 71% of physicians saying that the pandemic made the prescription drug epidemic worse. Perhaps even more telling, 94% of physicians said that the pandemic increased the number of their patients who experienced stress, anxiety, or other mental health issues. According to the National Institute on Drug Abuse, people with a substance use disorder (SUD) are at greater risk for contracting COVID, and breakthrough infections occur at a higher rate among vaccinated SUD patients than among those without SUD.1 The social isolation necessitated by the pandemic has worsened preexisting mental health issues among many people with SUD and has reduced access to care and support in many cases. Three-quarters of physicians surveyed believe that deaths from drug overdoses will increase even as the pandemic subsides.

2. Telehealth may decrease physicians’ ability to determine if a patient is at risk for drug misuse, compared to in-office visits. While 91% of physicians said they are confident about recognizing signs of drug misuses when seeing their patients in person, only 50% felt the same way about telehealth visits. And two-thirds of physicians worry they may be missing signs of drug misuse in their patients during the pandemic. Urine drug testing is an essential component of care for patients at risk for SUD, but Quest saw a steep decline in clinical drug testing in the early days of the pandemic. The rate of testing has increased since that early decline, and physicians have expanded options for testing despite limited in-person visits, with Quest’s network of Patient Service Centers throughout the country. 

3. Gabapentin is an important option for patients with chronic pain, according to the survey, with 87% of physicians prescribing it for their patients in the past 6 months, versus 65% who prescribed opioids. Gabapentin, an anticonvulsant, has little potential for addiction when taken as directed, but can produce a high when used with certain other medications. But 78% of physicians fear that their patients may turn to illicit fentanyl if they cannot get a prescription medication. Quest data shows that the positivity rate for nonprescribed fentanyl rose by 35% during the pandemic, compared to the positivity rate before it.

“The pandemic has overturned gains that have been made in addressing the opioid epidemic,” said Creighton Drury, Chief Executive Officer of Partnership to End Addiction, which co-sponsored the physician survey. “With a rising mental health crisis and more fentanyl in illicit drugs, we are truly facing a potential catastrophe.”

The survey was part of the 2021 Quest Health Trends® Report, the latest in a series of reports designed to bring objective data to the understanding of the nation’s healthcare challenges. This year’s report combined analysis of nearly 5 million deidentified test results from Quest Diagnostics with results from a Harris Poll survey of over 500 physicians, conducted in August 2021.

The report was authored by Jay G Wohlgemuth, MD, Senior Vice President, R&D and Medical, and Chief Medical Officer for Quest Diagnostics; Harvey W Kaufman, MD, Senior Medical Director and Director, Health Trends Research Program for Quest Diagnostics; and Mr Drury.

Published date: March 1, 2022


1. National Institute on Drug Abuse. “COVID-19 & Substance Use.” viewed online 30 January 2022.

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