Treating substance use disorders and addiction in the modern age
The current landscape of substance use disorders and addiction in the United States has allowed for new opportunities by which to consider and develop treatments, according to a presenter at the American Psychiatric Association Spring Highlights Meeting.
Nora D. Volkow, MD, director of the National Institute on Drug Abuse, highlighted several primary substance use concerns facing the country, one of which is the prevalence of overdose deaths related to the opioid crisis.
“Data from 2017 and 2018 [showed] a slight decrease, but the numbers are extremely high and changing rapidly,” Volkow said. “We have not been able to contain the opioid epidemic despite a lot of very effective interventions to try to regulate the factors that we know are very important in initiating and sustaining the crisis.”
Data from 1991 to 2011 showed a steady increase in overall opioid prescriptions in the U.S., and data from 1999 to 2018 reflected numerous increases in deaths involving opioids, specifically those involving synthetic opioids other than methadone. Although heroin use has declined in recent years, drugs like fentanyl, which is 50 times more potent than heroin, and its analogues have experienced a significant increase, according to Volkow.
Because the health care system is currently inundated with COVID-19 patients, patients with an opioid use disorder are experiencing difficulty receiving treatment and medication, according to Volkow.
Methamphetamine and cocaine use are also experiencing an increase in use comparable to that of fentanyl, Volkow said.
Another major substance use concern has resulted from the widespread legalization and availability of marijuana.
“There has been a significant increase in adverse health consequences from its use, including admissions to [the ED] because of acute psychotic reactions,” Volkow said. “There has been an associated concern about an increasing risk for schizophrenia, as well as for impulsive suicidality.”
Vaping technologies pose an additional health concern.
“It is very likely, as shown by some studies, that vaping increases the risk for consuming combustible tobacco,” Volkow said. “Plus, in and of itself, we cannot rule out the toxic or the negative effects of vaping to pulmonary function, so we are very concerned that these very high risks will lead us to lose some of the gains as it relates to [decreases in] smoking.”
Volkow noted that the prevalence of vaping and its related adverse effects on pulmonary function pose an even greater risk during the era of COVID-19, since users’ lungs may not be at the capacity to properly handle infection.
The current pandemic may also adversely affect individuals with respiratory systems already compromised by smoking, opiate use and methamphetamine use, according to Volkow.
The pandemic presents those with substance disorders with indirect risks, as well, such as housing instability/homelessness and incarceration. These individuals may also experience stress, stigma, limited access to medications for opioid use disorder and an increased risk for opioid overdose because social distancing measures may limit the ability for the administration of naloxone.
However, Volkow said that the pandemic may present opportunities, including increased use of telemedicine, new research into remote medical practices, establishment of mental health hotlines, deployment of virtual support meetings, the possibility of take-home medications for opioid use disorder, the development of web-based educational material that can be used to help in rehabilitation, and the release of nonviolent offenders with substance use disorder from jails and prisons, which might improve their long-term outcomes.
An overall research priority moving forward to address substance use and addiction should be the expansion of therapeutic options via novel treatments, such as neuromodulation and vaccines and immunotherapies, according to Volkow.
“The National Institute on Drug Abuse at the NIH realizes that changes are happening very rapidly,” Volkow said. “We have a unique opportunity with these terrifying experiments we have been thrown into with COVID-19 to try to gain information that perhaps will lead us to better treat individuals with substance use disorders and mental illness.” – by Joe Gramigna
Reference:
Volkow ND. Opportunities and challenges in addiction research. Presented at: American Psychiatric Association Spring Highlights Meeting; April 25-26, 2020 (virtual meeting).
Disclosures: Healio Psychiatry could not confirm relevant financial disclosures at the time of reporting.