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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

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
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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.2020.17477PubMedGoogle ScholarCrossref
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Wiest  K ,  et al.  High Plasma Buprenorphine Concentrations Decrease Respiratory Effects of Intravenous Fentanyl. American Society for Addiction Medicine; 2019.
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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 PubMedGoogle ScholarCrossref
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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 PubMedGoogle ScholarCrossref
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