People with substance use disorder — especially involving opioids or tobacco — are at a significantly higher risk for contracting COVID-19. What’s more, they also are more likely to develop a serious case of the virus and die, a new study funded by the National Institutes of Health has found.
Additionally, these findings mark still more examples of race-based health disparities that the pandemic has thrust into the spotlight.
The study, conducted by researchers at Case Western Reserve University, the Cleveland MetroHealth System, and the National Institute on Drug Abuse, looked at data from more than 73 million patients, focusing on people diagnosed with both substance use disorder and COVID-19.
They found that people diagnosed with substance use disorder in the last year were significantly more likely to develop COVID-19 than someone without a recent diagnosis, and that people diagnosed with a substance use disorder at some point in their lives were also at a higher risk than people without the disorder.
People with opioid use disorder, followed by tobacco use disorder, were at a particularly high risk, according to the study, which was published last week in the journal Molecular Psychiatry.
“The most severe association comes for opioid use disorder specifically,” said Nora Volkow, the director of the National Institute for Drug Abuse and one of the study authors.
“If you have an opioid use disorder, even after adjusting for compounding factors like ethnicity, age and gender, you are 10 times more likely [to contract COVID]. With tobacco, you are eight times more likely,” she said.
Both social and biological factors play into this heightened risk, Volkow said. Tobacco’s damage to the lungs makes it easier for smokers to contract the virus. Opioids depress the respiratory system, she noted, and researchers believe this makes opioid users more vulnerable.
“The social component is multiple factors. People addicted to drugs have to go and seek the drugs — this may expose them to situations with an increased risk of infection. Their life circumstances are more likely to put them at a greater risk of infection: You’re more likely to be homeless, or to end up in a jail or prison" if you have an addiction,” Volkow said.
“Individuals with substance use disorder are very stigmatized, and as a result of that, their willingness to go to health-care providers and take care of medical problems is less likely. I encounter these really tragic situations, where patients refuse to go to hospitals or see doctors because they’ve been mistreated.”
The racial disparities that have marked the coronavirus pandemic — with Black Americans disproportionately contracting and dying from the virus — are on display in the study as well. The researchers found that Black Americans with a recently diagnosed substance use disorder had a much higher risk of contracting COVID-19, and getting much sicker from it, than their white counterparts.
Now, the opioid epidemic and the COVID-19 pandemic are colliding, heightening the risks. After COVID-19 lockdowns began in Philadelphia, for example, more Black Philadelphians than whites died of overdoses for the first time in a decade.
The opioid crisis, sparked by prescription drug misuse and followed by a regulatory crackdown that led drug users to shift to illicit heroin and fentanyl, has been painted for years as affecting mostly white Americans. But nationally and locally, overdose death rates have been rising in Black communities for the last several years. Studies have shown that Black patients are less likely to access or even be offered effective treatments for opioid use disorder, like the popular addiction medication buprenorphine.
“The idea that Black patients were 'protected’ from the epidemic is upsetting, angering and frustrating,” said Utibe Essien, an assistant professor of medicine at the University of Pittsburgh who studies health equity. "And the fact that we’re seeing differences in access to treatment — but the crisis is expanding within that population.
“We spent so much time focusing on a very specific demographic,” he said. "Now, we’re seeing that maybe that focus has actually put populations marginalized in our health system at risk from the same crisis. And I think the pandemic definitely makes [helping those patients] more challenging.”
In Philadelphia, officials said they did not yet have data to determine whether Philadelphians with substance use disorder were particularly susceptible to COVID-19. But they said they were concerned about opioid users' and tobacco smokers’ risk for contracting the virus — and the racial disparities highlighted in the study.
“There are some very severe disparities for both African Americans and Latinos across the country and in Philadelphia, and higher rates of infection, hospitalization and death,” said Cheryl Bettigole, a physician who directs the city health department’s chronic disease and injury prevention division. “Smoking is a piece of that. The tobacco industry has been targeting Black and Latino neighborhoods with immense amounts of advertising, targeting advertising toward children, for years.”
To avoid contracting the coronavirus, at the very least, she said, smokers should make sure they are least six feet away from other people before smoking in public, and they should clean their hands before they touch their mask.
“This is also an opportunity, another push to quit smoking. There are so many good reasons to quit smoking. this adds another one with some more urgency,” she said.