Substance Use Disorders (SUDs) and related disorders are a significant source of morbidity and mortality and pose a substantial cost to society Over 20m people live with a SUD in the U.S., and since the drug epidemic started in 1999, there have been over 900,000 overdose fatalities. For an already vulnerable population, COVID-19 severely exacerbated the crisis for those with a SUD; drug overdose deaths shot up ~30% with close to 93,000 deaths in 2020, nearly 70,000 of which involved opioids.
SUDs are highly prevalent disorders that are characterized by an inability to control the use of a legal or illegal drug, medication, or other psychoactive compound. SUDs typically occur following prolonged, repeated use of a substance at high doses and/or high frequencies and can lead to significant health and social consequences.
Opioid Use Disorder (OUD) is a form of SUD characterized by uncontrolled and persistent self-administration of opioids, resulting in significant impairment, distress, and mortality. 3 million people in the U.S. have had or currently live with an OUD, and in 2020, about ¾ of overdose deaths involved opioids. The most common treatments for OUD are directed at achieving abstinence and include psychological and social interventions.
OUD’s societal effects are extremely far-reaching as the condition burdens multiple stakeholders. A retrospective secondary analysis using 2018 data from the National Survey on Drug Use and Health and the CDC WONDER Database attributed $787 billion societal cost to OUD in the U.S., with costs shouldered by the healthcare sector in the way of excess healthcare expenditures, the workforce due to lost productivity, the criminal justice system, and society in general because of premature mortality. The entire picture of overall impacts of the COVID-19 induced 2020 spike in SUD, OUD, and overdose fatalities will take some time to tabulate, but costs will certainly climb substantially higher.
Pain and OUD are Linked
For many patients, pain relief, and addiction are fundamentally linked, since the use of opioids to manage acute pain can lead to drug dependence. While opioids are indeed effective for most forms of acute pain, they are associated with a variety of adverse effects, including risk of addiction, constipation, and respiratory depression, the latter being the main cause of death among opioid users. Of individuals prescribed at least one day of opioids, 6% are still taking them one year later. Moreover, it is estimated that 8% to 12% of individuals prescribed opioids for chronic pain ultimately develop OUD.
There are limited pharmacological agents available to treat OUD, with the current options divided into two classes: (i) synthetic opioid receptor agonists, such as buprenorphine and methadone, and (ii) opioid antagonists, such as naltrexone and naloxone. These therapies suffer from a number of limitations, including high relapse rates, inconvenient treatment regimens, and access, partly due to treatments being controlled substances, which limit treatment availability and adherence, and an inability to maintain abstinence after medically assisted withdrawal.
Buprenorphine, methadone, and naltrexone are used as maintenance therapy with the primary goal of preventing relapse while naloxone is used as rescue therapy for opioid overdose. Access to treatments such as buprenorphine and methadone is limited by their treatment regimens and inherent risks of abuse, placing significant requirements and regulations on practitioners. In addition to these limitations, current treatment options are not highly effective; approximately 75% of patients undergoing OUD therapy experience relapse within one year of treatment. For abuse of other substances, such as cocaine or methamphetamine, no pharmacological agents have been approved.
Despite the limitations of current treatment options, the worldwide market for OUD therapies totaled $2.5 billion in 2020￼ Pre-pandemic, the market was expanding considerably at a compounded annual growth rate (CAGR) of 8.7% per year due to the significant increase in opioid use and the heightened response to the opioid crisis. COVID-19 did sytmie the OUD treatment market, but the rate of growth is projected to return to a pre-pandemic rate, signaling significant need and appetite for new treatment options.