Substance use disorder increases risk for COVID-19, complications

Data from more than 73 million patients’ anonymized EHRs revealed that those with a substance use disorder have an increased risk for COVID-19 and related complications, according to a study published in Molecular Psychiatry.

Previously, data on COVID-19 and tobacco were inconclusive, and there was little research on COVID-19 and other substances such as opioids, cannabis, cocaine and alcohol, according to researchers. The new findings, they said, highlight the importance of screening and treating substance use disorders (SUDs) as a pandemic control measure, particularly among African Americans and people who use opiates or tobacco, as they had the highest risk for adverse COVID-19-related outcomes.

“The lungs and cardiovascular system are often compromised in people with SUD, which may partially explain their heightened susceptibility to COVID-19,” Nora Volkow, MD, director of the NIH’s National Institute on Drug Abuse and one of the study’s authors, said in an NIH press release. “Another contributing factor is the marginalization of people with addiction, which makes it harder for them to access health care services. It is incumbent upon clinicians to meet the unique challenges of caring for this vulnerable population, just as they would any other high-risk group.”

In a retrospective case-control study using deidentified population-level EHR data from 73,099,850 patients, Volkow and colleagues identified 7,510,380 patients with an SUD (alcohol use disorder = 1,264,990; cocaine use disorder = 222,680; cannabis use disorder = 490,420; tobacco use disorder = 6,414,580; opioid use disorder = 471,520). Of those patients with an SUD, 722,370 were diagnosed with the disorder in the past year, which researchers said means they are more likely to have active substance use (alcohol use disorder = 83,100; cocaine use disorder = 14,800; cannabis use disorder = 27,650; tobacco use disorder = 611,750; opioid use disorder = 43,160). Patients with past-year SUD diagnosis had a higher prevalence of asthma, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, cancer, HIV, chronic liver disease, cardiovascular diseases, including hypertension and obesity. African American patients with past-year SUD diagnosis had a higher prevalence of asthma, chronic kidney disease, type 2 diabetes, hypertension, obesity and HIV compared with white patients.

After adjusting for age, gender, race and insurance types, researchers found that patients with past-year SUD diagnosis had a significantly increased risk for developing COVID-19 compared with patients without a recent SUD diagnosis (adjusted OR = 8.699; 95% CI, 8.411-8.997). People with opioid use disorder had the greatest risk for COVID-19 (aOR = 10.244; 95% CI, 9.107-11.524), followed by those with tobacco use disorder (aOR = 8.222; 95% CI, 7.925-8.530), alcohol use disorder (aOR = 7.752; 95% CI, 7.04-8.536), cocaine use disorder (aOR = 6.53; 95% CI, 5.242-8.134) and cannabis use disorder (aOR = 5.296; 95% CI, 4.392-6.388).

Patients with a lifetime SUD diagnosis also had a significantly increased risk for developing COVID-19 compared with those without an SUD (aOR = 1.459; 95% CI, 1.421-1.499). The greatest risks were among those with opioid use disorder (aOR = 2.42; 95% CI, 2.247-2.607), followed by cocaine use disorder (aOR = 1.57; 95% CI, 1.393-1.77), alcohol use disorder (aOR = 1.417; 95% CI, 1.335–1.504) and tobacco use disorder (aOR = 1.332; 95% CI, 1.294-1.372).

Patients with COVID-19 who had a lifetime SUD diagnosis were significantly more likely than other patients with COVID-19 to die (9.57% vs. 6.57%) or be hospitalized (40.96% vs. 30.09%).

Certain demographics also affected patient risk and outcomes. Researchers wrote that gender was not significant, but “race had the largest effect on COVID-19 risk” across all subtypes of SUD, particularly for opioid use disorder. African American patients with a past-year SUD diagnosis (aOR = 2.173; 95% CI, 2.01-2.349) and past-year opioid use disorder diagnosis (aOR = 4.162; 95% CI, 3.13-5.533) had a higher risk for COVID-19 than white patients. Among those with a lifetime SUD diagnosis and COVID-19, African American patients had higher rates of mortality (12.99% vs. 8.57%) and hospitalization (50.65% vs. 35.24%) compared with white patients. Hospitalization rates were also significantly higher among African American patients vs. white patients with past-year SUD diagnosis (53.66% vs. 37.7%).

“These results suggest that while comorbidities associated with SUD likely contributed to the increased risk of COVID-19 and to worse outcomes among SUD patients, specic pharmacological effects of drugs of abuse (e.g., opioid induced respiratory depression) as well as behavioral and socioeconomic factors could facilitate COVID-19 infection and increase risk for adverse outcomes,” researchers wrote.

References:

• NIH (2020). Substance use disorders linked to COVID-19 susceptibility. https://www.nih.gov/news-events/news-releases/substance-use-disorders-linked-covid-19-susceptibility. Accessed Sept. 16, 2020.
• Wang Q, et al. Mol Psychiatry. 2020;doi:10.1038/s41380-020-00880-7.