BETHESDA, MD—Researchers at the National Institute on Drug Abuse (NIDA) had been fighting one daunting national health crisis already when the COVID-19 pandemic launched its attack on the U.S. Now, these federal scientists face the dual challenges of reducing the impact of the opioid epidemic while ensuring patients with substance use disorders (SUDs) receive the care they need to recover in the midst of surging numbers of coronavirus cases and reduced access to medical facilities.
“We had not yet been able to contain the epidemic of opioid fatalities, and then we were hit by this tsunami of COVID,” said Nora Volkow, MD, director of NIDA, based in Bethesda, MD, in a video conversation with Francis Collins, MD, director of the National Institutes of Health.
Worse, each crisis has the potential to make the other worse.
Individuals with substance use disorders may be more susceptible to the novel coronavirus, Volkow noted in an article in the Annals of Internal Medicine. “And because of impediments to delivering care to this population, persons with SUD who develop COVID-19 may find it harder to get care. Those in recovery will also be uniquely challenged by social distancing measures.”
While the pandemic abruptly halted nearly all of NIDA’s studies, the institute issued nearly $4 million in new funding for COVID-19-related projects through mid-June. Early projects ranged from investigations into the effect of the virus on individuals with SUD, how addictive drugs and COVID-19 interact, whether drug use increases transmission rates, and how SUD affects risk of poor outcomes from COVID-19.
The last topic is of particular concern. Chronic respiratory diseases increase the risk of fatal overdoses in patients who use opioids therapeutically, while opioid use can cause hypoxemia with the potential sequelae of organ damage and death, Volkow wrote. That raises the question whether impaired lung function arising from COVID-19 could increase the mortality risk in the more than 12 million Americans who have opioid use disorder (OUD) or misuse opioids.
Similarly, the damage methamphetamines cause to the lungs and heart could also put its rapidly rising number of users at increased risk of hospitalization and death from the novel coronavirus.
Even as these patients face greater danger, the structures that support their treatment and recovery have become harder to access. “[T]hat relates, for example, to access of medications for opioid use disorders, which are the main strategy—and the most effective one—that we have to prevent people from dying from overdoses,” Volkow said.
Medication assisted therapy has become more challenging as the pandemic has reduced the ability of many clinics to start people with SUD on buprenorphine or to monitor those that had begun treatment earlier. In this setting, longer acting injectables may provide a more readily available option that reduces the exposure risk for both patients and physicians.
Social distancing has also increased the risk for patients with SUD.
“Epidemiological studies show that social isolation and neglect increase dramatically the risk of taking drugs, and, if you are trying to stop taking drugs, it increases that risk of relapse,” Volkow pointed out.
For those who use drugs, home alone may not be the safest location, even in a pandemic.
“Because of social isolation, if you overdose, the likelihood that someone can rescue you with naloxone is much lower,” Volkow said. “We don’t yet have statistics on about how that’s influencing fatalities, but we are very concerned.”
To get at the root of the substance use epidemic requires reversing trends that began long before the novel coronavirus first showed up in the U.S.
“We as a nation have to face the concept that we have made America vulnerable to drugs because we have eroded that social sense of community,” she concluded. “If we are to prevent future generations from getting addicted to drugs, we should build meaningful interactions between people. We should give each individual an opportunity to be part of a society that appreciates them.”
Despite the grim outlook today, Collins remained optimistic that more Americans could find their purpose in part because of the pandemic.
“Ironically, because of COVID-19, we are in the midst of a circumstance where economic distress is pressing on people and social distancing is being required,” he said. “But if you look back in history, often these times of national crisis have been times when people did have the chance to survey what really matters around them, and perhaps to regain a sense of meaning and significance.”
- Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Ann Intern Med. 2020;173(1):61-62. doi:10.7326/M20-1212