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Opioids

The Hidden Epidemic of Opioid Overdoses During the Coronavirus Disease 2019 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Psychiatry

Published Online: December 30, 2020

Viewpoint

Article Information and Disclosures

Thomas R. Kosten, MD¹;

Ismene L. Petrakis, MD²

Author Affiliations

¹Department of Psychiatry, Baylor College of Medicine, Houston, Texas
²Yale University School of Medicine, New Haven, Connecticut

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An unexpected tragedy of the coronavirus disease 2019 (COVID-19) pandemic is increased opioid and fentanyl overdoses, since many factors could have reduced opioid use disorder (OUD) and overdoses during this pandemic. Another tragedy is that both epidemics depend on vaccine development, but antifentanyl vaccine support includes no pharmaceutical and only 3 government investments, while industry and government support more than 120 COVID-19 vaccines. This discrepancy in support reflects stigma against those with OUD and failure of approved treatments to decrease overdoses.

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Article Information

Corresponding Author: Thomas R. Kosten, MD, Department of Psychiatry, Baylor College of Medicine, 1401 Calumet St, Unit 506, Houston, TX 77004 (kosten@bcm.edu).

Published Online: December 30, 2020. doi:10.1001/jamapsychiatry.2020.4148

Conflict of Interest Disclosures: Dr Kosten reported consulting fees from Alkermes, BioXcel, Indivior, Opiant, and US World Meds. He also reports grant support from the National Institutes of Health (National Institute on Drug Abuse and National Institute of Allergy and Infectious Diseases), including for a fentanyl vaccine, and the Department of Defense. Dr Petrakis reported consulting fees from Alkermes outside the submitted work; in addition, Dr Petrakis had a patent related to ketamine and naltrexone pending.

Meeting Presentations: Portions of this Viewpoint were previously presented as CC Grand Rounds: “Contemporary Clinical Medicine, Great Teachers: Treating the Other Epidemic, Anti-Opioid Vaccines,” for the National Institutes of Health; September 9, 2020; virtually presented to an audience in Bethesda, Maryland.

References

Alter A , Yeager C . COVID-19 impact on US national overdose crisis. Published 2020. Accessed November 20, 2020. http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf

Slavova S , Rock P , Bush HM , Quesinberry D , Walsh SL . Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend. 2020;214:108176. doi:10.1016/j.drugalcdep.2020.108176 PubMed Google Scholar

Ochalek TA , Cumpston KL , Wills BK , Gal TS , Moeller FG . Nonfatal opioid overdoses at an urban emergency department during the COVID-19 pandemic. JAMA. 2020;324(16):1673-1674. doi:10.1001/jama.2020.17477 PubMed Google Scholar Crossref

Wiest K , et al. High Plasma Buprenorphine Concentrations Decrease Respiratory Effects of Intravenous Fentanyl. American Society for Addiction Medicine; 2019.

Raleigh MD , Baruffaldi F , Peterson SJ , et al. A fentanyl vaccine alters fentanyl distribution and protects against fentanyl-induced effects in mice and rats. J Pharmacol Exp Ther. 2019;368(2):282-291. doi:10.1124/jpet.118.253674 PubMed Google Scholar Crossref

Heekin RD , Shorter D , Kosten TR . Current status and future prospects for the development of substance abuse vaccines. Expert Rev Vaccines. 2017;16(11):1067-1077. doi:10.1080/14760584.2017.1378577 PubMed Google Scholar Crossref

Wang QQ , Kaelber DC , Xu R , Volkow ND . COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Mol Psychiatry. 2020;1-10. doi:10.1038/s41380-020-00880-7 PubMed Google Scholar

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.