Substance Abuse Disorders Particularly Concerning During COVID-19 Pandemic

Nora D. Volkow, MD

As the coronavirus disease 2019 (COVID-19) attacks the lungs, smokers might be especially vulnerable.

In a virtual presentation as part of the American Psychiatric Association (APA) Spring Highlights Meeting 2020, Nora D. Volkow, MD, Director of the National Institute on Drug Abuse (NIDA), said there are a number of direct and indirect reasons those suffering from substance abuse disorders should be particularly concerned.

Volkow said because of the COVID-19 pandemic there is concern over a surge and increase in drug use.

Substance use is particularly concerning as the COVID-19 virus as individuals who smoke, vape, use opiates, or use methamphetamines are more vulnerable to some of the worst outcomes associated with the virus, including hospitalization and death.

“Last year we saw new phenomena of vaping associated with long injury that result in a death in some of the patients,” Volkow said. “It's now recognized that these cases of lung injury are associated with vaping of THC and when mixed with vitamin E that generate this reaction. This is a new technology and to our surprise when we believed that they were safe, that does not appear to be the case.”

Volkow explained that many of the pathologies created by COVID-19 infections in the lungs are in many similar to what is created by vaping.

There are also some indirect risks for individuals with substance use disorder in the current pandemic, including increased risk for disease transmission in homeless shelters due to housing instability, as well as increased risk due incarceration as prison populations are at the greatest risk for disease transmission during epidemics.

These individuals generally have reduced access to healthcare and recovery support services as well.

Volkow mentioned other challenges that may be prevalent during the ongoing crisis, included increased stress, stigma, access to medications, and limited access to meetings of peer-support groups or other sources of social connection.

Social distancing also increases the likelihood of opioid overdoses happening when there are no observers who are able to administer naloxone. While the concern during the pandemic remains, recent statistics show a mixed bag in regard to substance use in general.

Legislators and other stakeholders have made a dent in the opioid epidemic in recent years where Vicodin and oxycontin use has decreased by 30% within the last decade.

Another positive sign is cigarette smoking has declined in the last decade for school aged children, as well alcohol use and binge drinking. However, on the other hand, there has been significant increases in recent years for teenagers vaping both nicotine and THC.

According to a 2019 study, 11.7% of 12^th graders vaped nicotine daily in 2019, while 6.9% of 10^th graders and 1.9% of 8^th graders also vaped on a daily basis. The same can be said for THC, where 3.5% of 12^th graders, 3.0% of 10^th graders, and 0.8% of 8^th graders vape THC on a daily basis.

Another area of concern is the potency of cannabis has increased in the last 2 decades, increasing the risk of cannabis use disorder and other risk psychotic disorders.

“And it becomes very serious because regular use of marijuana is a pattern that is associated with greatest risk, not just being addicted to marijuana but the pattern associated with higher risk of psychosis and we see how behaviors that are leading to increases in risk,” Volkow said. “And pulmonary pathology are leading to negativity influence to get infected with COVID-19.”