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These estimates in 2019 were higher than those in 2002 to 2018.[i] While we wait for SAMHSAs 2020 report, there are indicators that the COVID-19 pandemic pushed substance abuse into hyperdrive and the result was fatal at times, especially in certain states.[ii]For instance: We are seeing an increase in amphetamine positivity rates up 240 percent and opioid positivity rates up by more than 430 percent

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Data availability All data presented in the study are available on request from the corresponding authors and are also included in the supplementary section

Indeed, one legend tells of how Sir Walters servant, seeing him smoking a pipe for the first time, threw water over him, fearing him to be on fire

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A major strength is its reliance on large cohort data supplemented by mechanistic insights