Science to Address Current

Drug-Related Concerns in the United

States: Overdose, Vaping, Cannabis

Wilson M. Compton, M.D., MPE

Deputy Director, NIDA
 NIDA General Approach:
ADDICTIONS as Diseases of Gene-Environment-Development
Biology Environment
Genes/Development Family/Social/Physical

DRUG/ALCOHOL

Brain Mechanisms

Addiction
Age
Overdose
 Evolution of Drivers of Overdose Deaths:
Analgesics Heroin “Fentanyl” Stimulants
40,000
36,359“Fentanyl”
35,000

30,000
30,231 Stimulants
(e.g. cocaine & methamphetamines)
25,000 70,630 Deaths in 2019
20,000 49,860 from Opioids (Prescription and Illicit)
15,000 14,139 Prescribed
10,000 14,019 Heroin
5,000

See: Compton WM & Jones CM, Ann NY Acad Sci, 2019;

Updated for 2019 from WONDER Database
ECONOMICS:
CHEAP Fentanyl
Precursor
Chemicals
Additional Consequences of Addiction
• Drug use while pregnant or parenting has led to increases in rates of neonatal
abstinence syndrome and removal of children into the foster care system.
• Increased rates of injection drug use have led to increases in acute cases of Hepatitis C
and outbreaks of HIV
U.S. Foster Care Removals for Infants < 1 Y.O. Acute Cases of HCV in USA
Overall

Parental
Substance Use

Source: Patrick SW, Frank RG, et al. Hospital Pediatrics, 2019. Zibbell et al. Am J Public Heath 2018;108:175-181
Universal Substance Use Prevention May Reduce
Later Use of Opioids & Methamphetamine
Past Year Methamphetamine Use 4½ to 6½ Years
Past Baseline
Targeting Youth to Prevent SFP/ISFP Control
Later Substance Use 5% 4.6%
4.2%
Disorder: An Underutilized 4%
Response to the US Opioid 3%
3.2%

Crisis 2.1%
Compton WM, Jones CM, Baldwin GT, 2%
Harding FM, Blanco C, Wargo EM
American Journal of Public Health 1% 0.5%
2019;109:2185-S189. 0.0%
0%
Study 1 Study 2 (11th Grade) Study 2 (12th Grade)
p<.05 p<.01 p<.05

Note: Study 2 included both ISFP and LST interventions

Source: R Spoth, et al. Arch Pediatr Adolesc Med. 2006;160:876-882
7
Solutions toward Responsible Prescribing: Guidance
Opioid Prescribing
Guidelines March 2016
• Intended for primary care providers
• Applies to patients >18 years old in
chronic pain outside of end-of-life
care
• Focuses on:
➢ Determining when to initiate or
continue opioids for chronic
pain
➢ Opioid selection, dosage,
duration, follow-up and
discontinuation
➢ Assessing risk and addressing
harms of opioid use
Dowell, Compton, Giroir.
2019;322(19):1855–1856
Patient-Centered Reduction or Discontinuation
of Long-term Opioid Analgesics:
The HHS Guide for Clinicians
Focuses on:
(1) Criteria for reducing or discontinuing opioid therapy
(2) Considerations prior to deciding to taper opioids
(3) Ensuring patient safety prior to initiating taper
(4) Shared decision-making with patients
(5) Rate of opioid taper
(6) Opioid withdrawal management
(7) Behavioral health support
(8) Challenges to tapering
Dosage changes, particularly rapid reductions in
dose, can harm patients or put them at risk if not
made in a thoughtful, deliberative, collaborative,
and measured manner.
Naloxone Distribution
Surgeon General’s Advisory on Naloxone and Opioid
Naloxone Saves Lives Overdose, April 5, 2018
• Direct intervention to save lives I, Surgeon General of the United States Public Health
– Nasal spray and Auto-injector Service, VADM Jerome Adams, am emphasizing the
formulations importance of the overdose-reversing drug naloxone.
• Next steps For patients currently taking high doses of opioids as
– Longer acting agents to address fentanyl prescribed for pain, individuals misusing prescription
risks? opioids, individuals using illicit opioids such as heroin or
– Respiratory stimulation? fentanyl, health care practitioners, family and friends of
people who have an opioid use disorder, and community
– Device development?
members who come into contact with people at risk for
opioid overdose, knowing how to use naloxone and keeping
it within reach can save a life.
• Medications for Opioid Use
Disorder are underutilized.

• Relapse rates are very

high.
 Science = Solutions: Improving Addiction Treatment
• Initiating buprenorphine treatment in the emergency department
improves treatment engagement and reduces illicit opioid use
• Extended release naltrexone initiated in criminal justice settings lowers
relapse rates and overdoses
• BUP-Nx more effective the XR-Naltrexone overall but appear equally safe
and effective after induction
Relapse-free survival

Lee JD, et al., Addiction 2015;100:1005-1014

and New Eng J Med 2016;374:1232-1242 Lee JD et al., The Lancet Nov. 14, 2017
HELPING END ADDICTION LONG TERMSM (HEAL) Initiative
• > $500M/year effort
• 41 states
ENHANCING PAIN • 400 Investigators
Advance Effective MANAGEMENT • > 25 HEAL research
Accelerate programs
Treatments For Discovery And
Pain Through • 12 NIH Institutes and
Development Of Centers
Clinical Research Pain Treatments
IMPROVING • From basic, prevention,
and translational
TREATMENTS Enhance
Expand research, to clinical trials
Therapeutic FOR MISUSE AND Treatments for and implementation
Options ADDICTION Infants with science
NAS/NOWS • Research ongoing for years
Develop New to come
and Improved Optimize
Prevention & Effective
Treatment Treatments
Strategies https://heal.nih.gov/
Vaping
 More U.S. Youth Use E-Cigs Than Combustible Cigs
2019 Past Month E-Cig vs.
Combustibles in USA Students
30%
Combustible Cigarettes
25.4%
25% Vaping Nicotine

20.2%
20% 5.3 million U.S. middle and
15%
high-school students
reported vaping in 2019
10% 9.0% Cullen et al. JAMA, November 5, 2019
5.7%
5% 3.4%
2.3%

0%
8th Grade 10th Grade 12th Grade
Miech et al. New England Journal of Medicine, 2019
The Recent Surge of Adolescent Vaping Has Leveled Off, but
Remains High as of Early 2020
Percentage of Students Reporting Any Vaping in Past Year
12th Grade
10th Grade
50 8th Grade
40.6
40 37.3
39.0
27.8 35.7 34.6
30
32.3

20 23.6
20.1 19.2
17.6
10 13.3

0
2017 2018 2019 2020

Source: University of Michigan, 2020 Monitoring the Future Study

 Daily Nicotine Vaping Holds Steady in MTF, and
All Grades Increasingly See It as Risky
Percentage of Students Reporting Vaping Nicotine Daily and Perceived Risk
Perceived Great Risk from Vaping
Vaping Nicotine Daily
e-liquid with Nicotine Regularly
2019 2020 2018 2019 2020
100 100

80 80

60 60 53.1 49.9
48.6
43.6 40.5
39.2
40 40 32.4 31.3 27.7
20 11.6 20
6.8 5.6 8.6
2 2
0 0
8th 10th 12th 8th 10th 12th

Percentages outlined in red denote significant difference between 2019 and 2020.
Source: University of Michigan, 2020 Monitoring the Future Study
E-Cigarette use may lead to use of Combustible Cigs
In a prospective study of 14 year old students,
E-Cigarette use predicted onset 1 year later of—
• Any Combustible Tobacco Product: 2.75 times more likely
(AOR-adjusted odds ratio)
• Smoking Cigarettes 1.73 more likely (AOR)
Leventhal, et al. JAMA 2015;314(7):700-707.

In a prospective study of 12-15 year olds,

E-Cigarette use predicted onset 2 years later of—
• Ever Using Cigarettes: 4.09 times more likely (AOR)
• Currently Smoking Cigarettes: 2.75 times more likely (AOR)
Berry, et al. JAMA Network Open 2019;2(2):e187794
 Safer = Safe
Conventional Conventional
Generally Higher Toxic Compound Cigarette
E-cigarette
vs
(ug / 15 puffs)
Levels of Toxic (ug) E-cigarette

Compounds in Formaldehyde 1.6-5.5 0.2-5.61 9

Conventional Acetaldehyde 52-140 0.11-1.36 130
Acrolein 4
Cigarettes than E- 4.6-14 0.07-4.19
Toluene 6.4-9.0 0.02-0.63 23
Cigarettes (but NNN 0.012-0.37 0.00008-0.00043 145
not zero levels) NNK 0.009-0.08 0.00011-0.00283 30
Cd 0.03-0.35 0.001-0.022 16
Ni 0.003-0.60 0.011-0.029 15

Goniewicz et al, 2014, Tobacco Control

Cannabis
 Cannabis: most commonly
used federally illicit drug in the U.S.
• •and
Almost
17. 32 million Americans 12 and older
report past month cannabis use.
• Approximately 4.8 million Americans met
criteria for cannabis use disorders in 2019.
• An estimated 3.5 million Americans used
cannabis for the first time; 1.4 million were
between the ages of 12-17.
Tetrahydrocannabinol (THC)
Psychoactive Ingredient in cannabis

Source: 2020 National Survey on Drug Use and Health, SAMHSA

 Past month cannabis use increasing in adults

2015 2016 2017 2018 2019

25%
23.0%
22.1% 22.1%
20.8% 7.7 M
19.8% 7.6M 7.5 M
20% 7.2M
6.9M

15%

10.2%
10% 8.6%
7.9% 22M
7.0% 6.5% 6.5% 6.7% 7.4% 6.5% 7.2% 18.5M
1.8 M 15.2M 16.8M
5% 1.8M 1.6M 1.6M 1.7 M 13.6M

0%
12 to 17 18 to 25 26 or Older
Age Group
Source: 2020 National Survey on Drug Use and Health, SAMHSA
Number of People Aged 12 or Older Who First Used Marijuana
in the Past Year (Millions)
12 to 17 18 to 25 26 or Older
2.0
1.8
1.6
1.4 1.4
1.2 1.2
1.0
0.9
0.8
0.6
0.4
0.2
0.0
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019

A filled in data point denotes a significant difference between that year and 2019.
Note: Estimates of less than 0.05 million round to 0.0 million when shown to the nearest tenth of a million.
Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2020
Adolescent Marijuana Use Remains Level
Percentage of Students Reporting Use of Marijuana/Hashish
Past Year Daily Use

50 8th Grade 10th Grade 12th Grade 50 8th Grade 10th Grade 12th Grade

40 40
35.2
30 30
28.0

20 20

10 11.4 10 6.9
4.4
0 0 1.1
92 94 96 98 00 02 04 06 08 10 12 14 16 18 20 92 94 96 98 00 02 04 06 08 10 12 14 16 18 20
Marijuana Vaping Remains Steady Following a Two-fold Increase
Over the Past Two Years
Percentage of Students Reporting Vaping Marijuana in Past Year and Perceived Risk
Perceived Great Risk from Vaping an E-liquid with
Vaping Marijuana
Marijuana Occasionally
50 8th Grade 10th Grade 12th Grade 50

40 40 36.4

30 30
23.7 23.2
22.1 20
20 19.1
9.5
10 10
8.1

0 0
2017 2018 2019 2020 8th Grade 10th Grade 12th Grade

Source: University of Michigan, 2020 Monitoring the Future Study

 12-17 Year Old Offspring Substance Use by MOTHER MJ Use
30% **
28.4%
** **
25.8% 25.4%
25%
** **
21.3% 21.2%
20%
** 16.1%
15.6% **
15% ** 13.7%
** 12.5%
11.8%
10% 8.4% **
6.1% * 6.7% *
5.0%
5% 4.0%
2.5%

0%
Marijuana Tobacco Alcohol Opioids
* RR only, p < .05 Never Lifetime Only <Weekly PY >Weekly PY
** RR and ARR, p < .05
Madras, Han, Compton, et al. JAMA Network Open 2019
 12-17 Year Old Offspring Substance Use by FATHER MJ Use
40%
*
35% 34.2%

30%
** **
25.1% * 25.0%
25% 23.6%

20% *
17.5% **
** 15.7% 15.1%
15% 13.3% **
11.6% *
9.8%
10%
6.8% *
5.5% 6.1% *
* 4.0%
5% 3.2%
1.7%
0%
Marijuana Tobacco Alcohol Opioids
* RR only, p < .05
** RR and ARR, p < .05
Never Lifetime Only <Weekly PY >Weekly PY
Madras, Han, Compton, et al. JAMA Network Open 2019
 U.S. state cannabis laws
Outdated as of
April 2021
• States with MML vary on:
• Allowable conditions and routes of
administration
• Dispensaries/home growth and
registries
• Testing, regulatory requirements
• States with Adult Use Laws vary on:
• Marketing, product labeling,
distribution (home growth, delivery)
• Public consumption
• Taxation
• Licensing
• Expungement and Equity
Source: The NORML Foundation, The Drug Policy Alliance, Map Chart, March 2021
 Colorado: Market share is shifting away from flower
towards concentrates
• Colorado’s retail sales in adult-use and medical
dispensaries combined grew from $675 million
in 2014 to about $1.75 billion in 2019,
including $338 million medical and $1,407
million recreational cannabis sales.
• In 2019, cannabis sales averaged $.45 million
per retail location in Colorado’s adult-use
market and $0.77 million per location in the
medical channel.
• Cannabis consumers spent $1,205 million
from January to July in 2020, including $250
million medical and $955 million recreational
cannabis sales.

Source: https://cannabusinessplans.com/colorado-cannabis-market/
 Changing landscape: Increasing THC (potency)
and decreasing CBD
15.07 2
15 THC % CBD % 14.26 14.35

12.27 11.98
11.92
11.52 1.5
11.13 10.91
10.36
9.93 9.75
9.58
10
THC Percent

8.76

1
8.14 8.02
7.20 7.15
6.11
5 5.34 0.51 0.49
0.47 0.47

CBD Percent
5.01 4.91
4.51 4.60 0.55 0.5
3.96 0.52
0.41 0.41 0.42 0.43 0.46 0.41
0.37 0.39
0.28 0.28 0.29
0.22 0.2 0.24
0.16 0.16 0.18 0.18 0.14
0 0
95 97 99 01 03 05 07 09 11 13 15 17 19

SOURCE: U Miss, Potency Monitoring Project

ED visits with cannabis related diagnoses in
San Diego county, 2006-2018
Typical Emergency 16,000 Primary Diagnosis
14,300
Department (ED) 14,000 Primary and Secondary Diagnosis
12,010
Diagnoses: 12,000
10,302
11,421
10,719

Accidents, 10,000

Psychosis, 8,000 7,354

6,000
Panic Attacks, 3,722
4,300
5,311

4,000
Hyperemesis, 1,851
2,362
2,000
CVD/Stroke 77 111 136 188 205 171 232 272 503 536 675
0
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Source: Roneet Lev, https://pttcnetwork.org/media/2594, mpisdcounty.net

Longer-term Outcomes: Association of Cannabis Use in Adolescence
and Risk of Depression, Anxiety, and Suicidality in Young Adulthood—
Systematic Review and Meta-analysis
4
3.46
3.5

2.5
Odds Ratio

2
1.5
1.5 1.37
1.18
1

0.5

Source: Gobbi G et al., JAMA Psychiatry (2019)

Odds ratios of psychotic disorders for the combined measure of
frequency plus type of cannabis used in London, Amsterdam, Paris

London (201 cases, 230 controls), Amsterdam (96 cases, 101 controls), and Paris (54 cases, 100 controls)
Error bars represent 95% CIs. OR=odds ratio. Source: DiForti M et al., The Lancet Psychiatry (2019)
 Multiple studies show altered brain structure and function in
youth who regularly use cannabis
Early (<18y) Cannabis Use Decreases Axonal Fiber Connectivity

Fimbria of
Precuneus
hippocampus,
to splenium
hippocampal
Commissure,
and
splenium

Axonal paths with reduced connectivity (measured with diffusion-weighted MRI)

in cannabis users (n=59) than in controls (N=33).
Source: Zalesky A et al., Brain (2012)
 Not all studies find
differences:
Subcortical structures

No differences between
regular cannabis users and
nonusers when participants
were matched on alcohol
use

Source: Weiland BJ et al., J. Neuroscience (2015)

 Adolescent Brain Cognitive Development (ABCD) Study
A Federal Collaboration: NIDA, NIAAA, NCI, NIMH, NIMHD, NICHD, NINDS, OBSSR,
ORWH,CDC-DASH, CDC-DVP, DOJ, NEA

Ten-year longitudinal study of ~12,000 children from age 10 to 20 years to

assess effects of childhood experiences, including use of cannabis and
other substances on individual brain development trajectories
Intersection of the SARS-
CoV-2 Pandemic and
Addiction
Structural and Social Challenges
for SUD During COVID-19
• Stress and Stigma
• Limited medication access and limited peer- Buffalo NY Methadone Clinic
March 2020
support groups/social connection
• Social distancing increases likelihood of opioid
overdoses happening with no observers who
can administer naloxone
• Job losses
• Housing instability/homelessness
• Incarceration (>50% of U.S prisoners have SUD)
and prison populations are at greatest risk
SARS-CoV-2 transmission
Social Interaction Preferred Over Drug
Drug preference increases when
social reward is punished

Sliding
door Partner
chamber

Resident
self-administration
chamber
Drug lever Social lever

Venniro et al., Nature Neuroscience 2018

Venniro et al., 2018
Drug Use Increases During Pandemic
Significant Changes in Drug Use Seen During the Fentanyl Positivity, by Age and Sex, Before and
Pandemic During COVID-19
Before COVID-19 During COVID-19
16
14 13.4

12 11
10.2
10 9.1 8.7
8.6
8 6.7
5.7 6
6
4.2 4.6
3.7 3.4
4 3.2
2.1
1.6
2
0

Millennium Health Signals Report™ COVID-19 Special Edition

Volume 2.1 Published July 2020 Niles JK et al., Population Health Management, 2020.
Higher COVID-19 Susceptibility and Worse COVID-19
Outcomes for Those with Substance Use Disorders (SUD)
Methods Risk Associated with Recent SUD Diagnosis and COVID-19
• Analysis of non-identifiable
electronic health records of
73 million patients in the
United States.
• Individuals with an SUD
constituted 10.3% of the
total study population, and
15.6% of the COVID-19
cases.

Source: Wang Q, Kaelber D, Xu R, Volkow ND. Molecular Psychiatry. 2020;26,30–39

More COVID-19 Diagnoses among Teens and Young
Adults Who Vape or Who Vape and Smoke Cigarettes
Methods
• An online national survey of adolescents
and young adults (n = 4,351) aged 13-24
years was conducted in May 2020.
• Assessing relationships among COVID-19-
related symptoms, testing, and diagnosis
and cigarettes only, e-cigarettes only and
dual use, sociodemographic factors,
obesity, and complying with shelter-in-
place.
Source: Gaiha, SM, Cheng, J, and Halpern-Felsher B. J Adolesc Health. 2020 Oct; 67(4): 519–523.
Findings
• Exclusive ever-use of combustible
cigarettes was only associated with
COVID-19–related testing, whereas both
past 30-day use and ever-use of e-
cigarettes and dual use were associated
with COVID-19 testing and positive
diagnosis.
• COVID-19 diagnosis was more likely
among adolescents and young adults
who use e-cigarettes only or are dual
users of e-cigarettes and cigarettes.
 100,000

0
20,000
40,000
60,000
80,000
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
Mar-16
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Reported Value

Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Peak in

Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
November 2017: 70,723

May-18
Jun-18
Predicted Value

Jul-18
Recent Increases in Overdose Deaths

Aug-18
Sep-18
Oct-18
Nov-18
Dec-18
Jan-19
Feb-19
Mar-19
Apr-19
May-19
Jun-19
(-3.0%)

Jul-19
Low Point in

Aug-19
Sep-19
Oct-19
February 2019: 68,631

Nov-19
Dec-19
Jan-20
Feb-20
Mar-20
Apr-20
NCHS Provisional Drug Overdose Death Counts: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm, April 11, 2021

May-20
Jun-20
12 Month Ending Provisional Counts (reported values) of Drug Overdose Deaths in the U.S.

Jul-20
(+24.6%)
August 2020: 85,516

Aug-20
Increased Overdose Death Rates During COVID-19 Pandemic
12-months Ending June 2019 Compared to 12-months Ending May 2020
Primarily Driven by Synthetic Opioids 38.4% increase in synthetic opioid
OD deaths across U.S.
98.0% - 10 western states
35.4% - 12 southern states & DC
32.1% - 6 midwestern states
21.1% - 8 northeastern states & NYC

Source: CDC Health Alert Network Advisory December 17, 2020, https://emergency.cdc.gov/han/2020/han00438.asp
SUD Services Have Shifted During the Pandemic
• Increased use of telemedicine
• Establishment of mental health hot lines
• Deployment of virtual support meetings
• Expansion of take-home medicines for MOUD
• Buprenorphine prescribing via Telehealth
• Release of non-violent offenders with SUD from jails and
prisons(might improve their outcomes)
• Development of web-based educational material that can be used
to help in rehabilitation
MAT Prescribing During Early Pandemic
March 2020–May 2020
• Extended-release intramuscular naltrexone
prescriptions fell statistically significantly below
forecasted levels
• Suggests patients had difficulty obtaining ER-
Naltrexone due to healthcare office closures and
need for provider to administer medication
• Buprenorphine and naloxone prescribing was at
forecasted levels
• Comparison prescriptions for other conditions were
above forecasted levels in March; at forecasted levels
April-May
• Reflects public health recommendations to increase
medication supplies on hand .
Source: Jones CM, Guy GP Jr, Board A., Drug Alcohol Depend. 2021;219:108486. Epub ahead of print.
Returning to Live with Parents During Emerging Adulthood
Is Protective for Heavy Drinking (based on Online Survey)
• Observed changes in drinking as a result of campus closure due to COVID-19, focusing on
the influence of living situation.
• Online survey of 312 college students across 3 state universities from a sample of a larger
study.
• Significant decreases in the typical number of drinks per week (from 11.5 to 9.9) and
maximum drinks per day (from 4.9 to 3.3).
• Those who moved from peers to parents showed significantly greater reductions in
drinking days (from 3.1 to 2.7), number of drinks per week (from 13.9 to 8.5), and maximum
drinks in one day (from 5.4 to 2.9).
• Those who remained living with peers or with parents, significantly increased frequency
(from 3.0 to 3.7 days and 2.0 to 3.3 days, respectively).

Source: White HR, Stevens AK, Hayes K, et al. Journal of Studies on Alcohol and Drugs, 2020; 81(6), 725–730.
Reduced Commercial Availability of Vape Products May Affect
Teen and Young Adult Vaping During the COVID-19 Pandemic

• Researchers at Stanford and UC San Francisco captured self-reported vaping habits

of 2,167 teen and young-adult e-cigarette users in May—two months after the
national emergency was declared and after MTF stopped gathering data for the
2020 survey.
• Over half of the respondents reported changing their use of vaping products, with
68% of those reporting that they had reduced their use or quit.
• Inability to purchase the products was one reason cited.

Source: Gaiha SM, Lempert LK, Halpern-Felsher B, JAMA Netw Open. 2020;3(12):e2027572.
Assessing Impact of COVID-19 in the ABCD Study
Youth substance use

The ABCD data used in this report came from the ABCD 3.0 Linked data from N=1080 youth who completed survey
data release (DOI: 10.15154/1519007) and the ABCD COVID-19 #1 during pandemic and completed a main study visit
Survey First Data Release (DOI: 10.15154/1520584) between Sept 2019 and Jan 2020

Courtesy of Will Pelham, UCSD (unpublished)

 Challenges to Current Population Projects
• Monitoring the Future (nationally representative 8th, 10th, and 12th grade samples)
– Data collection ended on March 14th with only 25 percent of the typical sample collected
(N=11,835 surveys from 112 schools)
• Population Assessment of Tobacco and Health—PATH (nationally representative household
cohort)
– Administered via ACASI in participant’s home
– 2020 special data collection of youth and teen adults (ages 12-19) suspended March 20,
2020 and restarted by telephone July, 2020
• Adolescent Brain Cognitive Development (ABCD) Study (~12,000 children followed
longitudinally)
– Three-year follow-up visits transitioned to virtual visits in mid-March
– Most data collected for these visits (excluding biospecimen collection and some sensitive
questions when participant privacy not able to be confirmed)
– Was in process of completing 2-year follow-up visits (~35% remaining) when in-person
visits suspended. Visit postponed; transitioned many planned measures to virtual while
determining how to resume in-person visits for neuroimaging
Take Home Messages
• The U.S. Overdose Epidemic has ACCELERATED during
the COVID-19 public health emergency.
• Science offers tests of solutions—both shorter term and
longer.

50