Leadership panel discusses the need for accessibility in the opioid use disorder treatment community.
Nora D. Volkow, M.D.
Director, National Institute on Drug Abuse
Lipi Roy, M.D.
Addiction Medicine Physician & Media Personality
Yuri Maricich, M.D.
Chief Medical Officer, Pear Therapeutics
The CDC recently reported that drug overdose deaths increased nearly 30 percent in the United States last year. What do you believe accounts for this increase?
Nora Volkow: The COVID-19 pandemic created a devastating collision of health crises in America. Rising fentanyl availability, decreased access to addiction treatment, increased social and economic stressors, and overburdened health departments converged in 2020 to increase drug consumption and overdose deaths.
Lipi Roy: It’s important to point out that drug overdose was an epidemic before COVID-19. But the record rise in drug-related deaths is a reflection of the pandemic’s disruptive effect on society.
Looking back on 2020, how did the effects of COVID exacerbate the OUD crisis? Can you speak to how pandemic-related stressors contributed to increased substance use?
NV: This has been an incredibly uncertain and stressful time for many people, and we know that stress increases the risk of substance use. The pandemic led to greater isolation, loss of jobs, economic hardship, evictions, the death of loved ones, and difficulty in accessing life-saving treatment.
Yuri Maricich: The COVID pandemic also further complicated recognition of SUD and OUD as well as access to evidence-based care. I’ve personally spoken to many patients who have identified how loss of employment, increased work volume, and social isolation resulted in initial use or relapse with opioids.
What are the barriers to treatment in accessing quality care for a person suffering from OUD?
YM: First, there is a lack of clinically proven treatment options. People living with opioid use disorder have only three classes of similar drug types: opioid receptor agonists and/or antagonists. Plus, credible remote care options are limited. Second, of the only 11 percent of patients who do get medication, the majority don’t receive the required behavioral treatment and also don’t keep using their medication beyond 30 days, which is critical for long-term recovery. Third, care for addiction is fragmented and separated from primary care and other medical services. Fourth, lack of virtual treatment options that employees can access easily at home (particularly during COVID) further limits treatment and remains a barrier to care.
Knowing the challenges of accessing physical treatments with a doctor, how has the landscape of evidence-based treatment shifted to include prescription digital therapeutics as a treatment option?
NV: It was encouraging to see telehealth options becoming more widely embraced and implemented during the pandemic, and research suggests that this expansion may enable greater access to treatment if continued into the future. Technology, including digital therapeutics, undoubtedly plays an important role in allowing doctors to meet people where they are, and support them with the care and treatment they need.
How can society embrace this new treatment option and directly address the opioid overdose crisis?
LR: Society needs to understand, first and foremost, that addiction is a chronic disease of the brain. It is not a moral failing. Second, it’s important to recognize that most people with addiction — once connected to the appropriate treatment and recovery services — get better. Unfortunately, of the 23 million Americans with SUD, only 10 percent access treatment. Stigma is a major barrier to treatment and care. People need to learn about evidence-based treatment options such as medications, behavioral therapies, and PDTs. Harm reduction strategies must also be widely implemented. We need to destigmatize people with SUD and help them receive the care they need and deserve.
