People with SUDs have increased risk for COVID-19 and worse outcomes

By Susanne Hiller-Sturmhoefel, Ph.D. / NIDA

One of the most common symptoms associated with coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is impaired lung function. People with substance use disorders (SUDs) also frequently have diminished lung function or are at risk for respiratory depression from opioid use. Therefore, it had been hypothesized early in the COVID-19 pandemic that people with SUDs may be particularly vulnerable to COVID-19 and its most severe health outcomes. A recent analysis of health records confirms this assumption. “It is clear from our analysis that people with SUDs are indeed at higher risk of contracting and suffering worse consequences from COVID-19. This is especially true for African Americans,” says Dr. Nora D. Volkow, Director of NIDA and senior author of the study.

Among all patients whose data were analyzed, 12,030 had been diagnosed with COVID-19. People who had ever had an SUD were significantly overrepresented in this group, making up about 16 percent of the COVID-19 patients compared with about 10 percent of the total sample. At the same time, people with a lifetime SUD diagnosis were 1.5 times more likely to develop COVID-19 than were people without SUD. COVID-19 risk also depended on the specific SUD diagnosis (see Figure 1). People with a lifetime diagnosis of OUD had the highest risk, and those with a lifetime diagnosis of CUD had the lowest risk, of COVID-19.

COVID-19 risk was particularly high among those with a recent SUD diagnosis (i.e., within the past year); their risk was more than 8 times higher than that of people without a recent SUD. Again, risk depended on the specific SUD. People with a recent OUD diagnosis were about 10 times more likely than people without recent SUDs to have COVID-19, whereas people with a recent CUD diagnosis were about 5 times more likely to have the disease.