COVID-19 Pandemic May Shed Light on Better Treatments for Substance Use Disorder
Abstract
Interventions like telemedicine and virtual support groups have exploded in response to social distancing. Now researchers can fully measure how well these interventions work.
Many of the pandemic-related risks to people with substance use disorders are indirect, including increased stress that may lead them to use substances, says Nora Volkow, M.D.
Research about how the COVID-19 pandemic affects people with substance use disorder (SUD) can inform strategies for providing treatment and social support in a post-pandemic world, said Nora Volkow, M.D., director of the National Institute on Drug Abuse in a presentation at the virtual APA Spring Highlights Meeting in April.
Volkow said that the pandemic has given researchers a chance to study how telemedicine, virtual support meetings, and take-home medications for opioid use disorder (OUD)—all measures that have increased because of social distancing—can affect outcomes in people with SUD.
“We realize that these changes are happening very rapidly, and they provide a unique opportunity—with this terrifying experiment that we have been thrown into with COVID—to try to obtain information that may lead us to better treatment of individuals with SUD and mental illness,” Volkow said. “Even in this devastation we can extract something that can help others in the future.”
Volkow also addressed the need to study how releasing nonviolent offenders from jails and prisons, as some municipalities have done, can affect their outcomes.
“The number of people in prisons has to be decreased because of the fear of contagion [with COVID-19],” she explained. “We can evaluate how to properly support these people and [we will be able to] document that those who receive support have better outcomes than those who stay in jail.”
Volkow noted that web-based education has proliferated in response to social distancing and the pandemic.
“This has expanded our capacity to provide training and education that will help in the recovery of individuals [with SUD] so they can be better prepared to take an active role in our society,” she said.
People with SUD may be particularly vulnerable to COVID-19, she added. First, the respiratory system can be compromised by smoking, vaping, methamphetamine use, or opioid use. Volkow noted that opioid misuse is particularly dangerous because it causes respiratory depression and raises the risk of hypoxia (low oxygen in tissue).
“Combine that with inflammation of the [cells] of the lung, and you can understand why this is such a lethal combination,” she said.
However, many of the pandemic-related risks people with SUD face are indirect, Volkow said.
“People who take drugs are much more likely to become homeless, and people who are homeless are much more likely to take drugs,” she explained. “It is almost impossible to … social distance or protect yourself [from infection with COVID-19] when you have home instability or food instability and you may be eating whatever you may find in a garbage can.”
Volkow discussed several of the challenges that may affect people with SUD during the pandemic, starting with increased stress. “When people are stressed, they drink more and they do more drugs. We know from other catastrophes this is a pattern and that stress increases the likelihood of behaviors that are detrimental to health,” she said.
Volkow added that social distancing may increase the likelihood of overdose death in people with opioid use disorder because people are using opioids alone, without anyone nearby to administer naloxone if necessary. ■
