Clinical impact of COVID-19 on people with substance use disorders

Abstract

Background People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. Methods an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. Results Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. Conclusion Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

The effects of substance use on severe acute respiratory syndrome coronavirus infection risks and outcomes

“…All the twelve included articles concluded, at least theoretically, that having a preexisting diagnosis of SUD increased the risk of infection with SARS-CoV2 [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]. Among those diagnosed with COVID-19, a significant proportion had diagnoses of SUDs [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]. This increased risk can be further stratified into socioeconomic disparities and medical comorbidities.…”

“…A large proportion of individuals with SUDs have underlying immunosuppressive conditions such as HIV or liver cirrhosis secondary to hepatitis C infection, which can make them more susceptible to severe illness from viral pathogens [ 7 ]. The mucociliary function of those who smoke tobacco, marijuana, or other substances is often suppressed leading to increased susceptibility to any viral or bacterial respiratory infections [ 2 ▪▪ , 8 , 15 ]. Apart from these risks, there is also data that suggests that smoking increases expression of the angiotensin-converting enzyme type 2 receptor [ 12 ▪ ].…”

“…Eleven of the twelve articles also concluded that a history of substance use increases the risk of most adverse outcomes from COVID-19 infection, including hospitalization due to severe disease and even death [ 2 ▪▪ , 3 ▪▪ , 7 , 8 , 9 ▪ , 10 , 11 ▪ – 13 ▪ , 14 – 16 ]Table 1 . It was estimated that the increase in the risk of hospitalization due to complications from COVID-19 ranged as high as 50% [ 3 ▪▪ , 9 ▪ ].…”

“…The remaining six articles were an evidence-informed policy brief, a matched cohort study, an observational study, an online survey, a retrospective case-control study, and a retrospective review. Only a limited number of articles directly assessed patient data or outcomes [ 3 ▪▪ , 7 , 8 , 9 ▪ , 10 ].…”

Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January–October 2020

“… 1 , 2 Evidence suggests that individuals with SUDs are at increased risk of COVID-19, 3 but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. 4 To address this gap, we conducted a retrospective study of patients tested for COVID-19 at a hospital system in New York City (NYC), an early COVID-19 hotspot and jurisdiction with high rates of opioid and other drug overdose (OD). 5…”