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The “colliding pandemics” of COVID-19 and substance use disorder put SUD patients at higher risk

Individuals with substance use disorder (SUD), especially opioid use disorder (OUD), are at increased risk for COVID-19, according to a study co-authored by Nora Volkow, Director of the National Institute on Drug Abuse.  Additionally, the excess risk was higher for Blacks than for Caucasians.

These findings “[highlight] the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support,” the authors said.

The study examined de-identified electronic health records from over 73 million individuals in the United States, of whom 12,030 had COVID-19. Of these, 1,880 had received a diagnosis of SUD at some point in their lifetime, and 1,050 had received that diagnosis recently.

The authors adjusted for age, gender, race, and type of insurance, and asked whether individuals with SUD were at higher risk for COVID-19 than those without SUD. SUDs included OUD, tobacco (TUD), alcohol (AUD), and other types of drugs.

Of the 1,880 individuals with COVID-19 and lifetime SUD, 320 had AUD (2.66%), 1,470 had TUD (12.22%), and 210 had OUD (1.75%). Of the 1,050 with recent SUD, 130 had AUD (1.03%), 840 had TUD (6.98%), and 90 had OUD (0.75%).

The risk for COVID-19 was dramatically elevated for any type of recent SUD, the analysis showed, with an adjusted odds ratio of 8.699 (95% confidence interval 8.411-8.997). The odds ratio for those with OUD was even higher, at 10.244. For TUD it was 8.222, and for AUD was 7.752.

Even if the SUD was in the past, the risk was higher compared to those who had never had an SUD, with an adjusted odds ratio of 1.459 for any SUD, and 1.459 for OUD.

In all comparisons, Blacks fared worse than Caucasians. Hospitalization rates were significantly higher in the context of COVID-19 without an SUD, with a lifetime SUD, or with a recent SUD. Death rates were also higher for Blacks than for Caucasians, except when comparing those with a recent SUD, for which the death rates were insignificantly different.

“Our findings at a macroscopic level provide evidence that SUD should be considered a condition that increases risk for COVID-19, a comorbidity that has particularly deleterious effects to Blacks. This has implication to healthcare as it relates to expanding testing, and making decisions of who might need hospitalizations with or without a lifetime SUD,” the authors concluded. “Our findings also underscore the importance of providing support for the treatment and recovery of individuals with SUD as part of the strategy to control the COVID pandemic.”

References

https://www.nih.gov/news-events/news-releases/substance-use-disorders-linked-covid-19-susceptibility

Rubin R. Substance Use Disorder Linked to Higher COVID-19 Risk. JAMA. 2020;324(16):1598. doi:10.1001/jama.2020.19686