Addiction 2021
Overdoses Rising, Vaping, Fentanyl and Stimulants Trending, Addiction Expert Says

5 takeaways:

Overdoses have accelerated during the COVID-19 pandemic, while vaping, fentanyl and stimulant abuse are on the rise. Overdoses were increasing before COVID, so it’s tough to separate out the pandemic effect. Prescription opioids and heroin overdose deaths have leveled off or dropped, but deaths from illicit fentanyl and stimulants such as cocaine and methamphetamines are up. (Preliminary data from the Centers for Disease Control and Prevention show that overdose deaths through late 2020 surged.)

Fentanyl is cheap, potent and surging. Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse at the National Institutes of Health, said that illicit fentanyl – not the kind used in surgeries – is a massive and growing problem. “In some ways, it’s much closer to the heroin market,” he said. It’s inexpensive and potent in tiny amounts, making it easy to smuggle and transport.

The excessive over-prescribing of opioids has slowed, but that has created new problems. The Centers for Disease Control and Prevention issued prescribing guidelines in 2016 to curb unwarranted prescribing. But it also chilled some responsible prescribing. “Clinicians became afraid of prescribing opioids,” Compton said. “… That led to a second set of issues.” Abruptly cutting a patient off opioids can lead to “significant withdrawal symptoms.” He said doctors need to carefully taper patients off opioids, substituting them with other agents.

Targeting middle-schoolers can help prevent later substance-use disorders. Prevention programs for young adolescents are especially important because the risk for developing a substance use disorder is highest for those who start using in their early teens, with addiction most likely to begin in the late teens. That’s also when the adolescent brain is still developing and therefore more vulnerable to lasting effects of substance use. But while several prevention programs aimed at middle- and high-school students have been found effective, they’re not widely used, Compton said.

Vaping is emerging as a major public health threat. In 2019, 5.3 million middle- and high school students reported vaping, Compton said. The percentage is about five times the percentage of those who smoke cigarettes. While kids are starting to hear that vaping is risky, use has been relatively steady over past three years. For public health officials, the messaging is tricky: They don’t want kids to vape or to smoke, but vaping is relatively safer than smoking. “Because for smokers, it’s quite clear that e-cigarette products have less harmful chemicals than a conventional cigarette,” Compton said. “But less does not mean none. So safer is not the same as safe.”

This program is sponsored by the American Society of Addiction Medicine, with support from Arnold Ventures. NPF retains sole responsibility for programming and content.

Dr. Wilson Compton
Deputy Director, National Institute on Drug Abuse
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