We are all fortunate for the ongoing work of the National Institute on Drug Abuse, a division of the National Institute of Health. Dr. Nora Voklow, who has long been directing NIDA, certainly does not sit on her laurels, but is constantly monitoring all aspects of substance use disorder in the United States, and she has been vocal about how the addiction and addiction treatment scenes have been evolving during the pandemic.
In this video recorded for the Psychiatry and
Behavioral Health Learning Network and this video for the McLean Institute for Technology in Psychiatry,
she notes that pathological substance use and substance-related deaths have
increased quite significantly since COVID came into our lives, partly in
connection with social isolation, as presumably the higher baseline level of
anxiety we have all experienced, and partly because Fentanyl, the killer drug
that has infiltrated the supply of opioids and caused so many overdose
fatalities in the past 20 years or so, now appears in supplies of cocaine,
meth, and even some ersatz prescription pills.
In addition, the chances of reversing overdoses via the use of Naloxone
(Narcan) dramatically decline when drug users are in isolation, away from
potential rescuers. In addition, she
presents evidence that individuals with substance use disorder, including those
who use high amounts of marijuana, are quite significantly more likely to develop
severe and potentially fatal levels of COVID.
On the other hand, as she notes, this has also been a time
of creative development of strategies to potentially reverse these trends
through various innovations such as more flexible availability of Suboxone
(Buprenorphine) and Methadone, and telehealth.
(Unfortunately, and this is my comment, not hers, the use of telehealth is
greatly thwarted by outdated rules that require clinicians to be licensed in
the every state where they are reaching patients, and the process of obtaining
these licenses is cumbersome, time-consuming, and expensive.) She even sees signs that a treatment like
Transcranial Magnetic Stimulation (currently used mostly for depression that
has not yielded to other treatments) may help reduce addictive urges and behavior.
If there has been any upside to the opioid epidemic it has
been a broader understanding that those with addictive disorders deserve treatment
and support rather than blame; similarly, the widespread prevalence of anxiety
and depressive symptoms that has come with the COVID pandemic and the measures
taken to stay safe have brought widespread recognition that it’s a good idea to
recognize and get help for mental health conditions that have so often been
subject to stigma.
