Site maintenance Wednesday, November 13th, 2024. Please note that access to some content and account information will be unavailable on this date.
Skip to main content
Full access
Datapoints
Published Online: 6 October 2020

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

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. adultsa
aClinical 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.

References

1.
Volkow ND. Collision of the COVID-19 and addiction epidemics. Ann Intern Med (Epub ahead of print, April 2, 2020).
2.
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.pdf

Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 1308
PubMed: 33019859

History

Received: 2 April 2020
Revision received: 19 April 2020
Accepted: 13 May 2020
Published online: 6 October 2020
Published in print: December 01, 2020

Keywords

  1. substance use disorder
  2. COVID-19
  3. chronic disease
  4. risk factor

Authors

Details

Hefei Wen, Ph.D. [email protected]
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.
Michael L. Barnett, M.D., M.S.
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.
Brendan Saloner, Ph.D.
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.

Notes

Send correspondence to Dr. Wen ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

Metrics & Citations

Metrics

Citations

Export Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format
Citation style
Style
Copy to clipboard

View Options

View options

PDF/EPUB

View PDF/EPUB

Login options

Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.

Personal login Institutional Login Open Athens login

Not a subscriber?

Subscribe Now / Learn More

PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Media

Figures

Other

Tables

Share

Share

Share article link

Share