Nora D. Volkow, MD Director of the National Institute on Drug Abuse National Institutes of Health Bethesda, MD

Challenges of Addiction Magnified by COVID-19 Epidemic Interview with:

Nora D. Volkow, MD Director of the National Institute on Drug Abuse National Institutes of Health Bethesda, MD

Dr. Volkow

Nora D. Volkow, MD
Director of the National Institute on Drug Abuse
National Institutes of Health
Bethesda, MD What is the background for this study? How does vaping, hookah use, inhaled marijuana, smoking etc impact the risk of coronavirus infection?  Could these activities account for some the risks and infections in younger individuals?


Response: Apart from older age, having underlying cardiopulmonary conditions is a known risk factor for the worst clinical course and outcomes of COVID-19, and many of those conditions are known to be caused or exacerbated by smoking. While evidence continues to emerge about how smoking might interact with COVID-19, it is a reasonable assumption that smoking could contribute to risk even in younger individuals.

We still don’t know how vaping—whether of nicotine or marijuana or just flavorings—contributes to the risk of infection or illness severity with the virus that causes COVID-19, but there are a number of reasons to be concerned. We have already seen lung illnesses caused by some vaping products, and evidence suggests vaping may disrupt lung epithelial cell function, which in turn increases viral susceptibility and may put individuals at increased risk of infection with the virus that causes COVID-19 or with more severe disease outcomes. Vaping is a relatively new technology, and as such, there are many unknowns. The rapid increases in vaping by young people over the last few years make this an area of concern, and thus an area where more research is urgently needed. How are those affected by substance use or recovery impacted by this epidemic?

Response: Apart from certain drugs like methamphetamine or opioids potentially contributing to cardiac or pulmonary health conditions, which may directly affect individuals’ vulnerability to infection, many impacts may be indirect. These include difficulty of accessing needed healthcare and recovery resources, as well as social isolation measures needed to curb the spread of the virus. Substance use disorders are prevalent among people experiencing housing insecurity or incarceration, and both of these populations may be especially vulnerable to contracting the virus.

Isolation is stressful for everyone, and people with substance use disorders may be especially vulnerable to its effects. Without the regular supports like friends and support groups, people in recovery may be at increased risk of relapse. Also, physical distancing measures and fear of contracting the virus may cause bystanders and emergency physicians to be reluctant to administer naloxone to individuals who are overdosing. In response to the pandemic, opioid treatment providers are making medication refill requirements more flexible in some areas, enabling patients to visit their clinics less often, and some support groups are using virtual tools to link people, but these measures only go so far and not everyone has access to them. Also, the DEA approved the use of telemedicine to begin buprenorphine treatment for new patients and continue monitoring current patients. What should readers take away from your report?

Response: History has shown that people with substance use disorders are a particularly vulnerable population when it comes to infectious disease. We have seen this with HIV over the last four decades. Their condition puts them at increased risk of infection, they have less access to healthcare, and they are often rejected by healthcare systems because of stigma. We should thus expect that people with substance use disorders will face added challenges and risks as the COVID-19 situation evolves. This is a time of remarkable hardship across the country and the world. However, it is in exactly these times that we must remember and protect the most vulnerable among us, and that includes the 20 million people in the U.S. with substance use disorders.


Collision of the COVID-19 and Addiction Epidemics
Published:Ann Intern Med. 2020.
Nora D. Volkow, MD

Published at on 2 April 2020



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Last Updated on May 12, 2020 by Marie Benz MD FAAD