COVID-19 Risk for People in Addiction Recovery?

Health and psychosocial risks associated with COVID-19 fall disproportionately on historically marginalized populations. I recently reviewed published studies on preliminary findings related to COVID-19 among people experiencing or recovering from substance use disorders (SUD).  Major findings from this review are summarized below.

*The COVID-19 pandemic is associated with an increase in substance use, SUD prevalence, and drug-related deaths in the U.S. (Dubey et al., 2020; Wardell et al., 2020)

*Self-medication of emotional distress related to COVID-19 and its socioeconomic effects (e.g., social isolation, loss of employment, and threat of housing instability) are linked to new populations of people experiencing alcohol and other drug problems, exacerbation of the severity of those with pre-COVID SUDs, and destabilizing recovery for some individuals with a past history of SUD (Dubey et al., 2020; Enns et al., 2020).

 *Adults with a SUD, when compared to those without a SUD, have a greater likelihood of co-occurring health challenges (cardiovascular disease, type 2 diabetes, cancer, obesity, and diseases of the lung, kidney, and liver) (Wang et al., 2020; Melamed, et al., 2020; Mallet et al., 2020). 

*Adults with a lifetime or recent SUD are at increased risk for COVID-19 infection, COVID-19 hospitalization, and COVID-19 death compared to people without a SUD history (Wang et al., 2020; Wei et al., 2020; Jemberie et al., 2020).

*COVID-19 infection, hospitalization, and death risks are particularly enhanced among adult African Americans and for adults with recent opioid use disorder (Wang et al., 2020; Schimmel et al., 2020).

*COVID-19 risks for people with a history of SUD are likely linked to three factors: co-occurring health challenges, specific drug effects, and socioeconomic adversity— including disparities in access to health and social services (Wang et al., 2020).

*While some cautions have been suggested regarding the interactions between medications used in the treatment of opioid addiction and medications used in the treatment of COVID-19 (Mansuri et al., 2020), Wang and colleagues (2020) found no differences in COVID-19 risk based on prescription or nonprescription of methadone, buprenorphine, or naltrexone.

All of the above findings are preliminary and subject to change through future investigations. At present we know nothing about the interactions of SUD and COVID-19 among adolescents and other special demographic and clinical populations, and we do not yet have studies on the specific effects of COVID-19 on people in different stages of recovery compared to people with active SUD or people without a SUD history.

Advocacy Implications

  1. Persons entering addiction treatment and recovery support services should be routinely screened and tested for COVID-19 and educated on their increased risk of COVID-19 infection and prevention strategies.
  2. Advocacy efforts should begin now to assure that people with a SUD history, as a high COVID-19 risk group, are included among priority populations for a COVID-19 vaccination when it becomes available.
  3. The increased COVID-19 risk experienced by people of color (and particularly older African Americans with an opioid use disorder) reinforces the need for advocacy efforts to address both the social ecology of COVID-19 and SUDs as well as racial disparities in access to healthcare.
  4. Studies need to be conducted on the effects of SUD recovery status on COVID-19 infection, hospitalization, and death risk.
  5. Studies are needed that illuminate the effects of COVID-10 on people involved in addiction treatment and recovery mutual aid organizations as well as the larger effects on these organizations.

There is much to learn on the relationship between COVID-19 and alcohol and other drug problems. We must act on available probationary data and do all we can to protect people impacted by these problems and their families and communities.

Defining people with a SUD history as an at-risk population warranting early access to a COVID-19 vaccination when available will encounter resistance as to whether the SUD population is “morally worthy” of being given priority over people without a history of SUD. That will again provide opportunities for public and professional education about addiction, addiction treatment, and addiction recovery.    

References

Dubey, M. J., Ghosh, R., Chatterjee, S., Biswas, P, Chaterjee, S. et al., (2020). COVID-19 and addiction. Journal of Diabetes and Metabolic Syndrome, 14(5), 817-823).

Enns, A., Pinto, A., Venugopal, J., Grywacheski, V., Gheorghe, M., et al. (2020). Substance use and related harms in context of COVID-19: A conceptual model. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 40(11-12). Doi: 10.24095/hpcdp.40.11/12.03.

Jemberie, W. B., Williams, J. S., Eriksson, M., Grönlund, A-S., Ng, N. et al, (2020). Substance use disorders and COVID-19: Multi-faceted problems which require multi-pronged solutions. Frontiers in Psychiatry, 11, 714.  

Mansuri, Z., Shah, B., Trivedi, C., Beg, U., et al, (2020). Opioid use disorder treatment and potential interactions with novel COVID-19 medications. The Primary Care Companion for CNS Disorders, 22(4). https://doi.org/10.4088/PCC.20com02703

Mallet, J., Dubertret, C., & Le Strat, Y. (2020). Addictions in the COVID-19 era: Current evidence, future perspectives, a comprehensive review. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 110070. Online ahead of print. Doi: 10.1016/j.pnpbp.2020.110070.

Melamed, O.C., Hauck, T.S., Buckly, L, Selby, P, & Mulsant, B. H. (2020). COVID-19 and persons with substance use disorders: Inequities and mitigation strategies. Substance Abuse, 41(3), 286-291.

Schimmel, J., & Manini, A. F. (2020). Opioid use disorder and COVID-19: Biological plausibility foir worsened outcomes. Substance Use Misuse, 55(11), 1900-1901.

Wang, Q. Q., Kaelber, D. C., Xu, R., & Volkow, N. D. (2020). COVID-19 risk and outcomes in patients with substance use disorders: Analyses from electronic health records in the United States. Molecular Psychiatry, https://doi.org/10.1038/s41380=020-00880-7.

Wardell, J. D., Kempe, T., Rapinda, K. K., Single, A., Bilevicus, E. et al., (2020). Drinking to cope during COVID-19 pandemic: The role of external and internal factors in coping motive pathways to alcohol use, solitary drinking, and alcohol problems. Alcoholism: Clinical & Experimental Research, online ahead of print. Doi: 10.1111/acer.14425.

Wei, Y., & Shah, R. (2020). Substance use disorder in the COVID-19 pandemic: A systematic review of vulnerabilities and complications. Pharmaceuticals, 13(7), 155. Doi: 10.3390/ph13070155.