COVID-19: An Opportunity, Challenge for Addiction Treatment, NIDA Boss Says

Pauline Anderson

April 28, 2020

The COVID-19 pandemic is posing significant challenges while also providing unique opportunities for patients with substance use disorders (SUD), a leading expert says.

Dr Nora Volkow

Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), said the pandemic has accelerated the use of telemedicine, making it easier for patients with SUD to access treatment. It has also led to the proliferation of more mental health hotlines, which is critical since the vast majority of these patients have comorbid mental illness.

In addition, COVID-19 has resulted in increased availability of "alternative" peer support mechanisms via cellphones or computers to aid individuals' sobriety.

Volkow spoke at the virtual American Psychiatric Association (APA) Spring Highlights Meeting 2020, which is replacing the organization's canceled Annual Meeting.

While methadone clinics have had to close during the pandemic, making it challenging for those on medically assisted treatment to receive methadone or buprenorphine, some of the rules and regulations have been relaxed in order to make these medications accessible without the need for in-person attendance at a clinic.

In addition, as recently reported by Medscape Medical News, the US Substance Abuse and Mental Health Administration has relaxed some of its own regulations regarding telehealth and opioid treatment programs.

Social Isolation, Stigma Intensified

A pandemic increases anxiety in the general population, but for patients with SUD who may be also be struggling with homelessness and comorbid mental illness, the situation can further exacerbate social stigma and isolation — leading to relapse, more overdoses, and overdose deaths, said Volkow.

Social interaction is "extraordinarily important" for patients and "one of the most powerful tools we have" to build resilience, she added.

Right now, said Volkow, "we are in the dark as to how COVID infections have affected the number of overdose deaths."

However, she noted that NIDA has issued a Notice of Special Interest to spur "urgent" research into how COVID-19 is affecting outcomes in patients with SUD.

"So even through this devastation, we can actually extract something that may help others in future," she said.

Volkow noted that during the pandemic it is critical to reinforce the importance of engaging in — and remaining in — treatment to SUD patients. 

It's also crucial, she said, to make patients aware of social support systems and behavioral interventions to help them cope with stress and to mitigate relapse risk.

COVID-19 and Relapse

Commenting on Volkow's presentation, Elie G. Aoun, MD, assistant professor of psychiatry, New York University, and vice-chair of the APA's Council on Addiction Psychiatry, told Medscape Medical News that it provided "exactly the kind of accessible information" clinicians need.

Aoun said he sees the impact of the COVID-19 crisis in his practice every day. Patients with SUD, he said, "are getting the short end of the stick."

Social distancing measures prompted by the pandemic can be "very triggering" for SUD patients, he said. One of his patients told him the current isolation, loneliness, movement restrictions, and boredom remind her of the way she felt when she used drugs.

Aoun said four of his patients have relapsed since the pandemic began. Two of them had just started treatment after years of using drugs, so this was a "major setback" for them, he said.

He and his colleagues were "not really prepared" to provide care via video link, which he believes is not as effective as in-person sessions.

In addition to disrupting patient care, said Aoun, the pandemic is forcing the medical community to face social determinants of health, such as poverty and homelessness, as they relate to addiction disorders and whether or not someone receives care.

American Psychiatric Association (APA) Spring Highlights Meeting 2020. Presented April 26, 2020.

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