The COVID-19 pandemic has likely contributed to an increase in opioid-related deaths in the United States, according to Nora Volkow, Director of the National Institute on Drug Abuse, part of the National Institutes of Health. She spoke with NIH Director Francis Collins in a recent web conversation.
After a long and dramatic rise in drug-related deaths through 2017, there was a “turnaround,” Dr Volkow said, and 2018 “was the first year where we did not see increases in the number of people that were dying from overdoses.” Much of the gain was due to the decreased number of overdoses from prescription opioids. This reversal as it relates to mortality “reflect many of the efforts from research and agencies to more properly prescribe opioids only to those who really need it, for pain management, and as well as the distribution of Naloxone, as well as the expansion of access to medication,” she said.
A rise in deaths from 2018 to 2019 was due in part to fentanyl and other synthetic opioids, and in part to “a new emerging threat,” psychostimulant drugs such as cocaine and methamphetamine, which together contributed to 25,000 deaths in 2019.
Then in 2020, the coronavirus pandemic began. “We don’t have accurate numbers of what the consequences are” regarding overdose fatalities, Dr Volkow said, “but from what we hear it’s estimated that at least there’s a 20% increase in the number of calls to the agencies reporting spikes in overdoses.”
Why should a viral pandemic accelerate drug-related deaths? Lack of community support networks has been a major factor, she said. “One of the first things that we’ve heard from the communities and the families afflicted by addiction [is that] that the support systems that were there to actually help them achieve recovery are no longer present.” In addition, access to treatment programs has become more difficult, including access to emergency departments, where many overdoses are treated. And stress from social isolation also plays a part.
Telehealth services have helped to overcome some of this loss of support, Dr Volkow said, and has provided the opportunity to test whether the standard protocols for medication-assisted treatment, including daily visits to the clinic for methadone, can be modified without reducing their effectiveness. “One of the questions that we’re now trying to answer from a scientific perspective is to evaluate the outcomes when people are given take-home methadone, because if we can show from evidence that the outcomes are as good as when you go daily, then we hope that that should help transform these policies.”
National Institute on Drug Abuse. Effects of COVID-19 on the opioid crisis: Francis Collins with Nora Volkow. July 6, 2020. Accessed July 27, 2020. https://www.drugabuse.gov/videos/effects-covid-19-opioid-crisis-francis-collins-nora-volkow