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Mortality from all types of drug overdoses increased by a whopping 30% over a 1-year period, Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), reported at the FDA Science Forum.

Data from the National Center for Health Statistics from October 2019 to October 2020 shows that mortality from overdoses from all types of drugs increased 30%, from 70,669 deaths in October 2019 to 91,862 deaths in October 2020, "and I think that that is a number that is very, very chilling," Volkow said at the forum. Among those overdose deaths in both years, more than half came from synthetic opiates -- "the most notable presence is fentanyl," she said. There was also a 46% increase in overdose deaths from other psychostimulants, mainly methamphetamine, and a 38% increase in deaths from cocaine overdoses.

Having any kind of substance use disorder (SUD) also affects the risk of getting COVID-19, she continued. According to done by Volkow and colleagues, "Regardless of the specific type of substance use disorder -- legal or illegal -- there was a significant increase in the likelihood of people that have a substance use disorder to become infected," she said. Their study, which included electronic health records from 7.5 million patients with an SUD diagnosis, found that patients with a recent SUD diagnosis -- within the past year -- were nearly nine times more likely to contract COVID-19 than patients without that diagnosis; for those with opioid use disorder in particular, their odds of contracting COVID were 10 times higher.

"And then when you ask the question, 'If you do get infected, what happens then to the risk of a negative outcome?'" such as hospitalization in an ICU, the need for ventilation, or mortality, Volkow said. Their study found that COVID-19 patients with an SUD had significantly worse outcomes (death: 9.6%, hospitalization: 41.0%) than other COVID-19 patients (death: 6.6%, hospitalization: 30.1%), and that African Americans with COVID-19 and SUD had worse outcomes (death: 13.0%, hospitalization: 50.7%) than Caucasians (death: 8.6%, hospitalization: 35.2%).

COVID also has presented structural challenges for SUD diagnosis and treatment, Volkow continued. Challenges include "access to medication for opiate use disorders, limited access to peer support groups, and the stress that social distancing generates," she said. In addition, "people taking opioids alone is much harder to actually reverse with Naloxone if no one is observing" it happening. And then there is "the loss of jobs, the homelessness, the despair -- those again are likely to have contributed to the vulnerability of people taking risks that otherwise they wouldn't have."

Fortunately, some government agencies have stepped in to help, Volkow said. "SAMHSA [the Substance Abuse and Mental Health Services Administration] and the DEA [Drug Enforcement Administration] changed policies on two of the medications that are most widely utilized for treating people with an opioid use disorder, which are also the most effective interventions that we have currently, to prevent them from overdosing and also to help them achieve recovery."

"The requirements for access to methadone, which means that you present yourself on a methadone clinic daily, were relaxed, and patients that in the past would have not been allowed to bring home methadone were allowed to do so," she said. "What we have heard from research communities and patient groups is that this, in many instances, has facilitated their ability to get access to methadone and also to be compliant" with their treatment regimen.

To find out how these new ways of prescribing have helped SUD patients -- and to see whether diversion has increased as a result of the relaxed rules -- NIDA is dedicating $100,000 "to try to understand how the COVID pandemic has influenced patterns that are associated with substance use, including our treatment with methadone, as well as buprenorphine," the latter of which can now be dispensed via telehealth rather than requiring the patient to be physically present, she said.

"And that again has made it much more accessible to people when in the past, they may have not even been able to access a physician with a waiver to prescribe the buprenorphine," Volkow added. "We want to understand how these practices can influence outcomes, so that we can learn and that post-COVID, we can improve the way that we provide with medication treatment for individuals with an opiate use disorder."

Prioritizing which areas need research is going to be a challenge, Volkow said. "That is one of the issues that has actually been very, very difficult, because there are many evidence-based interventions for prevention of substance use disorders that have shown to be effective; they don't just decrease the use of substances, they improve overall health outcomes and indications. And despite the clear-cut evidence of positive effects ... they are not actually being implemented. If we do develop scientific solutions, and then they are not taken to the next step, then that basically is wasted effort."

One thing the healthcare system must do is stop stigmatizing those with SUD, she added. "Certainly people are stigmatized who have substance use disorder, and therefore when they have gone to a healthcare system for getting care, they are much more likely to be discriminated [against], and this in turn interferes with a willingness to seek help when they need it, and is likely to have actually delayed their reaching out to the medical community for help ... We need to work together to address and get rid of stigma because it interferes with the outcomes of the patients and long term it's actually much more costly."

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