Nora D. Volkow, MD: Combating COVID-Era Issues in Substance Use Disorder


The director of NIDA discusses the unprecedented impact of the pandemic on overdose deaths—and how substance use disorder care may still reach greater capability when all is said and done.

The impact of COVID-19 on addiction medicine has been unprecedented—both in the acute impact of the early pandemic on the population’s mental wellness, and in its ongoing effect on community and health care resources.

Overdose deaths have increased by nearly 50% since 2020, and 2021 was the first year in US history when more than 100,000 people died from overdoses. At the same time, people with substance use disorders are at a greater risk of COVID-19 disease severity and mortality if infected.

In this historic hit to addiction disease management, one national leader sees innovations borne out of necessity that may help the field strengthen for the better.

In the first segment interview with HCPLive during the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans this week, National Institute on Drug Abuse (NIDA) director Nora D. Volkow, MD, discussed the “havoc” the pandemic had on substance use disorder and overdose prevention while also putting the same population at greater risk of preventable death from the virus.

“There has been a very negative impact in the bi-directionality of these 2 events, Volkow said. “You have a situation from the perspective of the social consequences that the pandemic had, that led all of us to stress—and another one that it has facilitated the entry of extremely dangerous drugs into our country.”

That said, Volkow believes the resolutions made by care systems during the pandemic—both to innovate against necessity, and to correct faults in the current system—could shape the future of substance use disorder care.

“I think we can absolutely take the knowledge we have—and the knowledge we gained during the COVID-19 pandemic—to come up with solutions to address the challenges we’re going to be facing,” Volkow said. “We will be able to succeed, and I would hope that we can actually learn from COVID and create systems that are more equitable and provide more sustainability.”

Such a system would absolutely require addressing the disparities at social, racial, cultural, and economic levels that permeate in US substance use prevalence and care limitations, she noted.

One positive that Volkow highlighted was the greater adoption of telemedicine during COVID-19. She highlighted the capability to more feasibly care for some of the field’s previously most out-of-reach populations, including patients in more remote rural areas, and the US prison and jail populations. Both diagnosis and prescription for substance use disorder has been simplified by telemedicine, she explained—and supplemental patient issues like comorbid mental illnesses are more easily addressed.

“I think it provides a system of care that’s much more sustainable that can be beneficial for many more conditions,” she said. “The question is, what are the conditions where ti requires a face-to-face intervention, and are there certain patients where this is more important than others?”

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