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Use of methamphetamine and fentanyl shot up after the pandemic hit the U.S. in March 2020, with a particularly sharp spike for the latter, according to .

The adjusted positivity rate of urine drug screens was up 78% for fentanyl and 29% for methamphetamine during the first 9 months of the pandemic compared with the same period in 2019, according to the report. While cocaine and heroin saw small increases initially, both fell below pre-pandemic levels by the end of 2020.

Much of the increased fentanyl use occurred in the Pacific region, with urine screen positivity more than doubling in Oregon, Alaska, California, and Washington. This increase coincided with the surge in synthetic opioid-related deaths in the region, as the CDC reported in December. As for methamphetamine use, Virginia and Nevada saw increases in positive drug screens of more than 300%.

The sustained increase seen with both drugs is "alarming," said Eric Dawson, PharmD, vice president of clinical affairs with Millennium, who contributed to the report. "These increases are incredible and the consequences are great," he added.

"Methamphetamine use poses unique challenges because there is no antidote for methamphetamine overdose and no FDA-approved medications indicated for the treatment of methamphetamine use disorder," the researchers wrote.

While fentanyl use was on the rise, there was a significant drop-off in positive screens for the more potent carfentanil, falling from 3.7% at the start of the pandemic to just 0.3% by December. Carfentanil's near-disappearance, they wrote, "leaves acryl fentanyl as the most commonly identified fentanyl analogue."

Positive screens for non-prescribed prescription drugs -- including gabapentin, oxycodone, and hydrocodone -- stayed relatively similar to pre-pandemic levels. The exception, however, was tramadol, which rose from about 3% to nearly 4%.

"These findings, combined with increasing law enforcement confiscations, suggest that tramadol remains a drug that should be monitored closely for potential misuse or diversion," the authors noted. "Despite less stringent, COVID-19-related prescribing regulations, non-prescribed hydrocodone and oxycodone positivity rates have not changed significantly, which is potentially optimistic news amidst the ongoing epidemic within a pandemic."

Finally, patients prescribed methadone in addiction treatment centers used non-prescribed and illicit substances whether they were taking their methadone or not, the researchers found. Fentanyl, cocaine, and cannabis were the most likely substances to be used by methadone patients. Patients not taking their methadone were more likely than patients taking the medication to use 10 of the 12 substances examined.

The findings regarding methadone patients "suggest a possible need to adjust the treatment plan to support recovery efforts, as well as potentially mitigate risks of overdose."

The study, which included 3.5 million unique patient specimens collected from Jan. 1, 2013 to Dec. 31, 2020, was limited by its cross-sectional nature. The researchers used Poisson regression to adjust positivity rates for differences in population characteristics including age and gender.

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