COVID-19 and Substance Use Disorders: Intertwined Epidemics

Study Group Summary: The COVID-19 pandemic has rapidly created enormous challenges for individuals, healthcare and judicial systems, and wider social and economic structures Science is urgently needed to address these challenges Among the most vulnerable populations are those with substance use disorders (SUD), although currently there is very limited information about the interactions of drug use and SUD with COVID-19 We can anticipate that drug use might affect COVID-19 incidence and exacerbate adverse consequences, based on known factors related to the acute pharmacological effects of drugs (e g , nicotine and methamphetamine might affect viral entry into cells) and their chronic effects (e g , methamphetamine increases the risk for pulmonary hypertension, cardiomyopathy and neuroinflammation;opioids increase the risk for hypoxemia);route of administration (i e , smoking or vaping tobacco or cannabis adversely affect pulmonary function);as well as the multiple social and economic factors that impact substance-using populations, including stigma, homelessness, and incarceration In the United States, the opioid epidemic continues to drive overdose fatalities and may exacerbate the COVID-19 crisis, and vice versa The COVID-19 pandemic jeopardizes the deployment of evidence-based interventions to prevent and reverse opioid overdoses and to treat opioid use disorders (OUD) Of necessity, restrictions on the dispensing of methadone and on the need for in-person visits for prescribing buprenorphine have been relaxed, which may improve treatment access Greater access to virtual environments, whether for telehealth or for virtual support groups, potentially increases the reach of treatment approaches However, the efficacy of these interventions long term and the proportion of those who benefit need to be evaluated Similarly, we need to examine the potential neuropsychiatric direct consequences of COVID-19 if it enters the brain (including the fetal brain during pregnancy), which is currently unknown, or indirect effects via immune system changes or from stress associated with the pandemic These could be further exacerbated by drug use;conversely, the stress from COVID-19 could also contribute to drug use, its escalation and to relapse Hence there is a need for research to assess the impact of COVID-19 on people with OUD and other SUD, including those with limited access to healthcare and other resources This study group will focus on critical areas to identify priorities for further research and opportunities for innovation Gail D'Onofrio will discuss how COVID-19 is affecting the treatment of OUD and overdose in emergency departments Sharon Walsh will discuss community-based strategies during COVID-19 to help people in treatment and recovery, including use of telehealth or virtual recovery groups in rural and urban settings Peter Friedmann will discuss issues affecting those with SUD in the criminal justice system, including those released from jails or prisons to decrease the census during the pandemic Linda Chang will discuss how COVID-19 may affect neurodevelopment in babies born to pregnant women with SUD Susan Tapert will discuss COVID-19 effects on routines, family, peer relations, substance use among teens, and implications for brain development And Elena Koustova will discuss the translational opportunities to expand screening and treatment of COVID-19 in patients with SUD