COVID Impacts

Drug Use a Factor in COVID
Breakthrough Infections

— Cocaine, cannabis users at highest risk

The ongoing stress and uncertainty of COVID-19 have led to increased demand for mental health services from psychologists in the United States—but conditions like anxiety and depression aren’t the only mental health issues people are facing. Experts say misuse of opioids and stimulants is also on the rise—and psychologists are in a good position to help. On top of the other risks arising with substance misuse, those with substance use disorders (SUD) are both more likely to develop COVID-19 and experience worse COVID-19 outcomes, including higher risk of hospitalization and mortality (Wang, Q., et al., Molecular Psychiatry, 2020). Fully vaccinated individuals with substance use disorders were more likely to have breakthrough COVID-19 infections than those without such disorders, researchers found. Adjusted analyses found that breakthrough infections were higher in patients with all types of substance use disorder, except tobacco, and were the highest among cocaine users (HR 2.06, 95% CI 1.30-3.25) and cannabis users (HR 1.92, 95% CI 1.39-2.66), reported Lindsey Wang, PhD, of Case Western Reserve University in Cleveland, and colleagues. However, when matching patients with and without substance use disorders for lifetime comorbidities and social determinants of health, only increased risk for breakthrough infection among cannabis users remained significant (HR 1.55, 95% CI 1.22-1.99), the authors wrote in World Psychiatry.

Substance abuse as the risk factor for acquiring SARS-CoV2

People with SUD are at heightened risk for pulmonary infections due to-
  • Substance abuse related pre-existing cardio-pulmonary morbidities
  • Mucociliary dysfunction
  • Compromised immunity
  • Altered health-seeking behavior and inadequate access to health care delivery
  • Failure of rehabilitation strategies due to social distancing
  • Housing instability
Individuals with pre-morbid respiratory and cardiac pathologies (i.e. chronic obstructive pulmonary disease, cardiovascular diseases) are established as high-risk population to acquire novel severe acute respiratory system corona virus (SARS-CoV2) and it leads to greater mortality. As SUD is associated with plethora of cardio-respiratory and metabolic ailments, it’s highly probable that they are also at the heightened risk for COVID-19.