Approximately 47,000 Americans died of opioid overdoses in 2018. Authorities reported that 5,4 million middle and high school students vaped in 2013. And just two months ago, approximately 2,800 cases of vaping-related lung injuries led to hospitalizations, and 68 deaths.
Before the middle of March, these figures commanded attention. As the death toll from coronavirus rises and the economic costs of attempting to control its spread wreak havoc, the public health focus has shifted dramatically.
In the background, however, the opioid epidemic and the vaping crisis continue to exacerbate an already overburdened public health system.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, remarked that it is a uniquely American problem.
Volkow spoke with Kaiser Health News about the emerging science surrounding the relationship between COVID-19 and vaping and opioid use disorder, as well as how these underlying epidemics may increase the risk to individuals. Her comments have been edited for clarity and length.
We have been experiencing vaping and the opioid epidemic concurrently, and are now in the midst of a third epidemic. Does this alter the nature of the United States’ coronavirus response?
It creates a situation unlike what we observe abroad. It forces us as a nation to urgently multitask, focusing on the urgent needs of COVID while not ignoring the other epidemics ravaging the United States. That is certainly difficult.
What evidence supports the connection between vaping and the coronavirus?
Due to the novelty of vaping, there are no data to indicate whether there are differences in outcomes between vapers and non-vapers. There is no scientific evidence reported. We will start seeing it.
We know from all the cases of acute lung injury that vaping, particularly certain chemical combinations associated with THC vaping, led to death. Death was caused by pulmonary dysfunction. We know from animal experiments that vaping alone, without the addition of any drugs, can cause inflammatory lung changes.
We already know that COVID patients with comorbid conditions, especially those affecting the lungs, heart, and immune system, are more likely to experience negative outcomes.
One can anticipate a relationship. In the interim, due to the existing data, we must exercise extreme caution. The prudent course of action is to strongly advise vapers to quit.
Young people appear to have a lower risk of developing COVID complications. Does vaping affect this?
We are aware that there have been youth deaths. Attempting to comprehend the unique vulnerabilities of young people is an extremely important area of study.
Why would you take the chance when you are aware that vaping causes inflammatory changes in the lungs? We know in medicine that damaged tissue is more susceptible to injury.
Large centers where you observe an increase in COVID-19 cases are more likely to have co-occurring vaping disorders.
Vaping is predominantly practiced by young people, but also by many older people who would otherwise smoke tobacco. [Smoking] increases the risk as well. Even though the sample sizes were insufficient, overall, smokers with COVID have performed worse than nonsmokers.
Let’s discuss opioid use disorder. What types of co-occurring conditions are we beginning to observe between opioid use disorder and COVID-19?
People with an opioid use disorder are frequently smokers. The act of smoking itself increases lung damage.
We are aware that opioids are immunosuppressants. This has been studied extensively. Additionally, nicotine can impair immunity and the cell’s ability to respond to viral infections.
One of the effects of opioids is to depress respiration. If the severity is sufficient, they stop breathing. This is what causes death.
Regardless of whether you overdose or not, when you take opioids, your breathing rate and blood oxygen levels tend to decrease.
The [COVID] infection targets the pulmonary respiratory tissues. It inhibits the capacity for oxygen transfer into the blood.
If you have COVID and are taking opioids, the physiological effects will be significantly worse. You will not only experience the effects of the virus, but also the depressive effects of opioids in the respiratory system [and] in the brain, which will result in significantly reduced blood flow to the lungs.
What about additional supports for individuals in recovery?
Closing are community support systems such as syringe exchange programs. Methadone clinics are shutting down. If they are not closing, they are unable to process the same number of patients because the staff is becoming ill or because the space where the methadone clinic was located cannot accommodate so many individuals. People cannot use public transportation to get to their methadone clinics.
According to our investigators, the capacity of the health care system to initiate patients on medication for opioid use disorder, particularly buprenorphine, has decreased significantly. Many of the buprenorphine initiations were done in health care facilities that are saturated with COVID.
What is being done to address these issues?
In the past, if you were a physician or nurse practitioner and you wanted to start a patient on buprenorphine, you were required to see the patient in person. This has evolved. It is now possible to initiate buprenorphine treatment via telehealth. This is extremely valuable.
There is increased reimbursement for telehealth, which expands treatment access. There are also apps that provide addicts with access to mentors or coaches, as well as to individual and group therapies.
This is one of the aspects that the COVID crisis has actually accelerated. These could facilitate treatment in the future, even if COVIDs are eradicated.
Vaping Public Health COVID-19 Opioids
Dr. Nora Volkow, who heads the National Institute on Drug Abuse, details how emerging science points to added challenges for these patient populations and the public health system.