Virus Pandemic, Opioid Epidemic Collide Around Social Distancing

The physical distancing needed to mitigate the worst pandemic in more than a century could exacerbate the opioid epidemic and other public health emergencies that continue to loom in the face of Covid-19, the head of NIH’s drug abuse research programs said.

Before Covid-19, the nation was already grappling with an opioid crisis, rising rates of methamphetamine use, and a surge in teenage vaping. Those haven’t gone away during the pandemic, potentially making those groups more vulnerable to the new respiratory virus, Nora D. Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, cautioned.

At the same time, the coronavirus pandemic, and all of the stress and fear that go with it, could spur an even bigger increase in overdoses, she said.

“We have two crises going on at the same time,” Volkow said in an interview. “We have an epidemic of opioid addiction and overdose deaths. And over that epidemic comes this pandemic of Covid that is actually reaching out in ways we never have seen.”

Social Distancing

Opioid and other drug treatment clinics around the country are revamping their rehabilitation techniques to encourage social distancing. The federal government recently relaxed rules for patients to take their daily methadone or buprenorphine doses home with them, which gives treatment facilities the ability to clear their crowds.

Ensuring access to medication without having to group together people who have potentially compromised immune systems is crucial to avoid what health policy analysts have called a “perfect storm” of viral spread and relapse.

But social distancing can also lead to stress, which Volkow said increases the likelihood of a relapse. Fewer in-person counseling sessions and therapy groups also are difficult for people recovering from drug addiction.

Social and physical distancing have “significantly interrupted the ability for patients to receive these types of treatment and support,” Yngvild Olsen, a medical director at the Institutes for Behavior Resources/REACH Health Services, a substance abuse treatment center in Baltimore, said.

Some counseling sessions have moved to an online forum and there’s a growing number of online recovery support services, Olsen said. Reports of security breaches for platforms like Zoom have caused concern around the country, however, and the American Society of Addiction Medicine is updating its current support group guidance to reflect that, she said.

In addition, an overdose is more likely to happen when no one is around, Volkow said.

Some treatment clinics offer naloxone in their take-home methadone and buprenorphine kits. But Volkow is hoping researchers and industry can mobilize to develop monitoring devices that can alert when someone is going into an overdose and that can automatically inject naloxone.

“It’s an urgent problem,” she said. “And right now it’s more urgent than it has ever been.”

‘Many Layers’

The emergency of an opioid crisis amid a viral pandemic compounds an array of other issues, from provider shortages to mental health to lung damage.

“It has many, many layers and wrinkles about the complexities that are brought about in the intersection of Covid with substance use disorders,” Volkow said.

People with underlying medical conditions are at greater risk of severe illness or death if they become infected with Covid-19, and people who abuse drugs or alcohol are more likely to have lung damage, she said.

Volkow outlined the risks in a recent opinion article on Covid-19 and addiction epidemics in the Annals of Internal Medicine.

Specifically with opioid use disorder, people die because the lungs can’t oxygenate and people can’t breathe. SARS-Cov-2, the virus that causes Covid-19, infects the respiratory system.

“This is one of the things that I’m extremely scared of, as people that have overdoses are also infected with Covid, the likelihood that they can be reversed could be much lower,” Volkow said. “And then we will see increasing mortality.”

Adding to the stress is the increase in vaping in the U.S., which the FDA said in March could compound the risk of the virus.

“We know that vaping itself can basically destroy your lungs so if you get infected and your lungs are not working properly, you’re at greater risk of negative outcomes,” Volkow said. “So then it follows that if you vape, you’re putting yourself at risk.”