People with substance use disorders may be at higher risk for infections with SARS-CoV-2

Press release

Wednesday, October 6, 2021

Concomitant health disorders appear to contribute to an increased risk, suggests an NIH study.

An analysis of the electronic health records of nearly 580,000 fully vaccinated people in the United States found that the risk of breakthrough SARS-CoV-2 infection in vaccinated patients with substance use disorders was low overall, but higher than the risk in people vaccinated without substance use. troubles. The study was published today in Global Psychiatry and led by researchers from the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and Case Western Reserve University in Cleveland, Ohio.

The study also found that concurrent health conditions and adverse socioeconomic determinants of health, which are more common in people with substance use disorders, appear to be largely responsible for the increased risk of infections pierced by SARS-CoV-2. People with substance use disorders – such as alcohol, cannabis, cocaine, opioids and tobacco use disorders – also had high rates of serious outcomes, including hospitalizations and death from breakthrough infections.

“First and foremost, vaccination is very effective for people with substance use disorders, and the overall risk of COVID-19 in vaccinated people with substance use disorders is very weak. Said NIDA director Nora D. Volkow, MD, and one of the study’s lead authors. “We must continue to encourage and facilitate vaccination against COVID-19 in people with substance use disorders, while recognizing that even after vaccination, this group is at increased risk and must continue to take protective measures against COVID-19. “

Scans from the early stages of the pandemic found that people with substance use disorders were at increased risk of SARS-CoV-2 infection and were more likely to have serious illness. requiring hospitalization or resulting in death. This was especially true for blacks with a substance use disorder. Since then, vaccines have become widely available for people aged 12 and older, dramatically reducing the risk of COVID-19 and serious illness.

However, clinical trials evaluating the effectiveness of these vaccines did not specifically include people with substance use disorders. Since many people with substance use disorders are immunocompromised due to drug use and concomitant illnesses, researchers hypothesized that this population may be at increased risk for infections. chronic after being vaccinated.

To study these questions, the researchers analyzed the electronic health records of nearly 580,000 people in the United States with and without substance use disorders who were fully vaccinated against COVID-19 between December 1, 2020 and on August 14, 2021, and who had not been infected. with SARS-CoV-2 before vaccination. The infection status was based on the ICD-10 diagnostic code for COVID-19 or a laboratory test confirmed the presence of SARS-CoV-2 and associated RNA.

They determined the proportion of people in each group who contracted SARS-CoV-2 at least 14 days after their final vaccination. This analysis was repeated after matching patients with and without substance use disorders for demographic characteristics; socioeconomic factors that influence health, such as housing or job instability; and lifelong physical illnesses, such as high blood pressure, heart disease, obesity or diabetes. The team also examined whether fully vaccinated people with breakthrough infections had a different risk of hospitalization and death compared to corresponding people without breakthrough infections.

Researchers found that the risk of breakthrough infections was significantly higher in people with substance use disorders than in those without: disorders. The risk of breakthrough infection varied slightly among people with different substance use disorders, ranging from 6.8% for people with tobacco use disorders to 7.8% for those with tobacco use disorders. with a cannabis use disorder.

The study suggests that the increased risk of breakthrough infections in people with substance use disorders was primarily due to concurrent illnesses and unfavorable socioeconomic characteristics. When these factors were controlled, people with most substance use disorders no longer had high rates of breakthrough infections. The only exception was for people with cannabis use disorders, who were still 55% more likely to experience breakthrough infections than people without substance use disorders, even though patients with cannabis-related disorders. cannabis users tended to be younger and had fewer concurrent health problems than those with other substance use disorders. The authors hypothesized that factors such as the detrimental effects of cannabis on lung and immune function may have contributed to the higher risk of breakthrough infection in this group.

Additionally, breakthrough infections have been found to significantly increase the risk of serious outcomes, including hospitalization and death, regardless of the presence of substance use disorders. Among people with substance use disorders, 22.5% of those with a breakthrough infection required hospitalization and 1.7% died during the study period, compared with 1.6% and 0.5%, respectively, in people with substance use disorders but without a breakthrough infection. In addition, the risk of serious outcomes after a breakthrough infection was higher in patients with substance use disorders than in those without substance use disorders.

“From previous studies, we knew that people with substance use disorders could be particularly vulnerable to COVID-19 and its related serious consequences. These results highlight that although the vaccine is essential and effective, some of these same risk factors still apply to breakthrough infections, ”said Rong Xu, Ph.D., professor at the Center for Artificial Intelligence in Drug Discovery at Case Western Reserve University. . “It is important to continuously assess the effectiveness of COVID-19 vaccines and the long-term effects of COVID-19, especially in people with substance use disorders. “

About the National Institute for Drug Abuse Control (NIDA): NIDA is a component of the National Institutes of Health, US Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute implements a wide variety of programs to inform policy, improve practice, and advance the science of addiction. For more information about NIDA and its programs, visit www.nida.nih.gov.

About the National Institutes of Health (NIH):The NIH, the national agency for medical research, comprises 27 institutes and centers and is part of the US Department of Health and Human Services. The NIH is the principal federal agency that conducts and supports basic, clinical, and translational medical research, and studies the causes, treatments, and cures for common and rare diseases. For more information about the NIH and its programs, visit www.nih.gov.

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