Clinical Risk Factors for COVID-19 Among People With Substance Use Disorders.

Abstract

Back to table of contents Previous article Next article DatapointsFull AccessClinical Risk Factors for COVID-19 Among People With Substance Use DisordersHefei Wen, Ph.D., Michael L. Barnett, M.D., M.S., Brendan Saloner, Ph.D.Hefei WenSearch for more papers by this author, Ph.D., Michael L. BarnettSearch for more papers by this author, M.D., M.S., Brendan SalonerSearch for more papers by this author, Ph.D.Published Online:6 Oct 2020https://doi.org/10.1176/appi.ps.202000215AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As COVID-19 spreads across the United States, people with substance use disorder may be susceptible to contracting the disease and developing serious complications. COVID-19 epidemiology suggests that cardiovascular and chronic respiratory diseases and diabetes may increase the risk for severe illness (1). People with opioid use disorder and methamphetamine use disorder deserve particular attention, given the detrimental effects of long-term drug use on pulmonary function, other major organ systems, and the immune system (1).We used individual‐level data from the 2015–2018 National Survey on Drug Use and Health (NSDUH). Our sample consisted of three mutually exclusive groups of civilian, noninstitutionalized adults ages 18–64: those with past-year opioid or methamphetamine use disorder, those with other types of past-year substance use disorder (i.e., abuse of or dependence on alcohol, illicit drugs other than opioid and methamphetamine, or both), and those who did not have a past-year substance use disorder (2).We used logistic regression models to estimate differences among the groups in the overall and age-stratified rates of having an underlying condition that may heighten the risk for severe illness following COVID-19 infection. Models were adjusted for gender, race-ethnicity, and urban/rural residence. We used the Stata/SE “svy” procedure to account for NSDUH’s sampling weights and complex survey design (2).Nonelderly adults with opioid or methamphetamine use disorder were most likely to have an underlying condition (adjusted rate, 44.2%; p<0.001), compared with those with other types of substance use disorder (31.4%) and those without a past-year substance use disorder (33.5%). The higher rates of having an underlying condition among those with opioid or methamphetamine use disorder were observed consistently across all age categories (Figure 1).FIGURE 1. Adjusted rates of having clinical risk factors for COVID-19 severity and mortality among nonelderly U.S. adultsaaClinical risk factors recognized by the World Health Organization and the Centers for Disease Control and Prevention and included in the National Survey on Drug Use and Health questionnaire are cardiovascular disease, hypertension, chronic respiratory diseases, diabetes, cancer, chronic liver diseases, kidney disease, and HIV/AIDS. Rate estimates and 95% confidence intervals (whisker lines) were estimated with Stata/SE.Our findings underscore that opioid and methamphetamine use disorders are associated with underlying conditions identified as risk factors for COVID-19 severity and mortality. People with these conditions are an underserved group who may need additional support to ensure equal access to testing and treatment, especially as COVID-19 continues to impose unprecedented pressures on the nation’s health care system. Social distancing, self-quarantine, and other public health measures may disrupt their access to addiction treatment (2). Additional efforts are required to mitigate those unintended disruptions.Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston (Wen); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston (Barnett); Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore (Saloner). Tami L. Mark, Ph.D., and Alexander J. Cowell, Ph.D., are editors of this column.Send correspondence to Dr. Wen ([email protected]).The authors report no financial relationships with commercial interests.References1 Volkow ND. Collision of the COVID-19 and addiction epidemics. Ann Intern Med (Epub ahead of print, April 2, 2020).Crossref, Medline, Google Scholar2 2018 National Survey on Drug Use and Health: Methodological Summary and Definitions. Rockville, MD, Substance Abuse and Mental Health Services Administration, 2019. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHMethodsSummDefs2018/NSDUHMethodsSummDefs2018.pdfGoogle Scholar FiguresReferencesCited byDetailsCited byBehavioral Health Workforce Development in the era of COVID-19: Examples From a State-Funded Intermediary Organization26 April 2022 | Community Mental Health Journal, Vol. 58, No. 8Experiences with substance use disorder treatment during the COVID-19 pandemic: Findings from a multistate surveyInternational Journal of Drug Policy, Vol. 101The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview8 February 2022 | Healthcare, Vol. 10, No. 2Integrated vs nonintegrated treatment for perinatal opioid use disorder: retrospective cohort studyAmerican Journal of Obstetrics & Gynecology MFM, Vol. 4, No. 1Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region22 November 2021 | PLOS ONE, Vol. 16, No. 11 Volume 71Issue 12 December 01, 2020Pages 1308-1308 Metrics Keywordssubstance use disorderCOVID-19chronic diseaserisk factorPDF download History Received 2 April 2020 Revised 19 April 2020 Accepted 13 May 2020 Published online 6 October 2020 Published in print 1 December 2020