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Collision of Sud and Covid-19: a Nida Update

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Collision of Sud and Covid-19: a Nida Update COLLISION OF SUD AND COVID-19: A NIDA UPDATE 1 Welcome, your facilitator will be: Samson Teklemariam, LPC, CPTM • Director of Training and Professional Development for NAADAC • NAADAC, the Association for Addiction Professionals • www.naadac.org • [email protected] 2 www.naadac.org/webinars 3 1 www.naadac.org/nonopiate-therapy-opiate-pain- webinar Cost to Watch: Free CE Hours Available: 2 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non- members: $25 4 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions 02 Handouts Audio (phone preferred) Polling Questions 5 NAADAC Webinar Presenter Jack B. Stein, MSW, PhD • National Institute on Drug Abuse (NIDA) • Chief of Staff • Office of Science Policy and Communications (OSPC), Director 6 2 7 Webinar Presenters Jennifer Hobin, PhD Kurt Rasmussen, PhD Will M. Aklin, PhD Deputy Director and Director Director Legislative Advisor Office of Science Policy and Division of Therapeutics and Behavioral Therapy Communications Medical Consequences (DTMC) Development Program NIDA NIDA NIDA 7 8 Webinar Presenters Redonna Chandler, PhD Phillip Rutherford, BA Jessica Hulsey, BA Director of AIDS Research Program Chief Operating Officer Founder and Healing Communities Study NIDA Faces and Voices of Recovery Addiction Policy Forum 8 Collision of SUD and Covid-19: A NIDA Update December 18, 2020 12:00 p.m.–2:00 p.m. EST 9 9 3 Today’s Agenda • Part 1: . Overview ‣ Jack B. Stein, MSW, Ph.D., NIDA ‣ Jennifer A. Hobin, Ph.D., NIDA . Treating Substance Use Disorders (SUD) ‣ Kurt Rasmussen, Ph.D., NIDA ‣ Will M. Aklin, Ph.D., NIDA . HIV/AIDS and SUD ‣ Redonna Chandler, Ph.D., NIDA • Part 2: . Patient and Family Perspectives ‣ Philip Rutherford, Faces & Voices of Recovery ‣ Jessica Hulsey, Addiction Policy Forum 10 10 Overview Jack B. Stein, MSW, Ph.D., NIDA Jennifer A. Hobin, Ph.D., NIDA 11 11 2019 Provisional Number of Deaths Overdose Death Counts 40,000 Prescription Opioids • Overdose deaths involving synthetic 35,000 narcotics, such as fentanyl, continued a Fentanyl steep increase in 2019, reaching 37,162 30,000 cases. Heroin • Overdose deaths involving prescription 25,000 opioids or heroin continued a gradual Methamphetamine decrease to a respective 14,376 and 20,000 14,291 cases. Cocaine • Overdose deaths involving cocaine or methamphetamine continued 15,000 increasing to a respective 16,207 and 16,536 cases. 10,000 Note: Data for 2019 is not final and subject to change and therefore provisional. Source: Ahmad FB, Rossen LM, 5,000 Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2020. Data accessed 10/01/2020 0 12 4 Overdoses Grew Dramatically During the Pandemic ST 13 13 Drug Use Increase During COVID Total US Increase 31.96% 19.96% 10.06% 12.52% Millennium Health Signals Report™ COVID‐19 Special Edition: SignificantTotal Changes Study in Drug Population Use During the Change Pandemic inVolume Unadjusted 2.1 Published Positivity July 2020 Rate for Cocaine, Fentanyl, Heroin and Methamphetamine 14 COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States Quan Qiu Wang, David C Kaelber , Rong Xu , Nora D Volkow 4 Wang et al., Mol Psychiatry 2020 15 5 16 SM # 38 HELPING END ADDICTION LONG TERM (HEAL) Initiative ENHANCING PAIN Advance MANAGEMENT Effective Accelerate Treatments For Discovery And Pain Through Development Of Pain Treatments Clinical Research IMPROVING TREATMENTS Expand Enhance Therapeutic FOR MISUSE AND Treatments for Options ADDICTION Infants with NAS/NOWS Develop New and Improved Optimize Prevention & Effective Treatment Treatments Strategies 17 HEALing Communities Study Justice Community Opioid Innovation Network 18 States + PR 88 communities >25,000 justice‐ involved persons • Has the rate of overdoses changed? • Compiled >120 guidelines/resources for justice • Impact on treatment initiation and retention systems responding to COVID-19 • Impact on drug access in the community • Advisory group to provide real-time • Challenges to providers and first responders information to NIDA on COVID-19 impact in • Challenges to those with SUD justice settings 18 18 6 Structural Challenges for SUD During COVID • Stress • Stigma Buffalo NY Methadone Clinic March 2020 • Access to medications for OUD • Limited access to peer support groups and other sources of social connection • Social distancing increases chance of overdose with no one present to administer naloxone 19 Opportunities in SUD Treatment • Expanded use of telemedicine . Prescribing outside of state where providers are registered . Expanded Medicare coverage of telehealth services . OTP therapy/counseling via audio calls rather than audio/video • Easier access to medications for OUD . Buprenorphine to new/existing patients via telehealth/telephone (methadone initiation must be in person) . 28 day methadone take home doses . Surrogate take home/door step delivery for people under quarantine 20 20 NIDA Notice of Special Interest for Research at the Intersection of COVID and SUD • Nearly 90 applications funded • Solicitation open until March 2021 21 21 7 NIDA Notice of Special Interest for Research at the Intersection of COVID and SUD • Examples of funded projects: . How does telehealth access affect OUD treatment, including in rural settings? . What is the impact of methadone take home dose policy on treatment retention/adherence and drug use? . What factors mediate the effects of COVID on drug use in people with SUD? . How has the pandemic affected adolescents? Pregnant and postpartum women with SUD? . Development of digital smartphone apps that can facilitate counseling and recovery support in the context of COVID 22 22 Updated: August 31, 2020 Milestone highlights TRANS-NIH COVID-19 EFFORTS Rapid Standup & Execution In response to COVID-19, NIH has multi-IC collaborative efforts to address interdisciplinary challenges Buffalo NY Methadoneassociated Clinic with the Marchpandemic 2020 EARLY APRIL Technologies for Safe Release Public-Private FNIH (Foundation for the NIH) from Sheltering in Place collaborates with NIH to launch Partnership (ACTIV) the Accelerating COVID-19 RADxSM Tech RADxSM-UP Therapeutics: Preclinical WG Therapeutic Interventions & SM SM RADx -ATP RADx -rad Therapeutics: Clinical WG Vaccines (ACTIV) Public-Private Partnership Clinical Trial Capacity WG Vaccines WG EARLY JUNE Ramp-up of additional Rapid Clinical Data Acceleration of Diagnostics Coordination Pregnant & SM TRANS- (RADx ) programs Virtual Community Lactating Women Workshop on NIH Buffalo NY Methadone Clinic & Children Jumpstarting Access to COVID-19 Clinical Data for COVID-19 EARLY JULY EFFORTS Multisystem Inflammatory RADx Data Hub effort and ResearchMarch 2020 Syndrome in Children (MIS- RADxSM-ATP program kick off C) – PreVAIL Social & Behavioral Clinical Trial LATE JULY Community Engagement Networks COVID-19 Prevention Trials Jumpstarting Access to Research Alliance (CEAL) Network (COVPN) Clinical Data for COVID-19 Against COVID-19 in Research Virtual Workshop Disproportionately Affected Communities (OTA solicitation, awards pending) Preclinical Therapeutics EARLY AUGUST These efforts directly support the NIH’s Strategic Priorities outlined in its Strategic Plan for COVID-19 Research: Kickoff of increased focus on community engagement efforts & PreVAIL announced Improve Advance Support Accelerate Research Prevent and Fundamental Research to Research to to Improve Redress Poor Knowledge Improve Detection Advance Prevention COVID-19 Treatment Outcomes 23 23 Buffalo NY Methadone Clinic March 2020 Buffalo NY Methadone Clinic March 2020 https://www.drugabuse.gov/drug-topics/comorbidity/covid-19-resources 24 24 8 Congressional Interest in NIDA Research • Opioid crisis • Rising rates of stimulant overdose NIDA Director Dr. Volkow discusses methamphetamine use with the Freshman Working Group on Addiction 25 25 An Effective but Inaccessible Methamphetamine Treatment: Contingency Management • Opportunity • Challenges . CM is a behavioral treatment in . Treatment programs receiving which behavioral change targets federal funds are allowed to award (such as drug abstinence) are set a maximum of $75/patient/year and carefully monitored, and . More is disallowed by HHS under rewards are issued for anti-kickback statute compliance . Legal concerns have disincentivized uptake of CM . Meta-analyses indicate that CM is . Effective CM protocols provide the most effective behavioral more than $75 treatment for stimulant addiction . range ~ $200-$2000 26 26 Congressional Interest in NIDA Research • Opioid crisis • Rising rates of stimulant overdose • Adolescent tobacco and vaping use • Cannabis • Facilitating research with controlled substances NIDA Director Dr. Volkow discusses methamphetamine use with the Freshman Working Group on Addiction 27 27 9 Changes in U.S. Drug Policy—2020 Election • Marijuana . Arizona . Mississippi . Montana . New Jersey . South Dakota • Hallucinogens . Oregon (psilocybin) . Washington, DC • Other drugs . Oregon (decriminalization of all controlled substances) Map from National Conference on State Legislatures 28 28 Standardized THC dose 29 29 30 30 10 NIDA Strategic Plan Winter 2020 Spring 2020 Present outline to Present Draft outline NACDA; framework to Publish RFI NACDA Fall 2021 Spring 2021 Begin drafting; NACDA approval; RFI Report to Winter 2021 final NIH approval NACDA NACDA feedback; Finalize draft Program staff Launch and promote We are here Consult with review NIDA Strategic Plan!
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