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

Abstract

Background Evidence suggests that individuals with history of substance use disorder (SUD) are at increased risk of COVID-19, but little is known about relationships between SUDs, overdose and COVID-19 severity and mortality. This study investigated risks of severe COVID-19 among patients with SUDs. Methods We conducted a retrospective review of data from a hospital system in New York City. Patient records from 1 January to 26 October 2020 were included. We assessed positive COVID-19 tests, hospitalizations, intensive care unit (ICU) admissions and death. Descriptive statistics and bivariable analyses compared the prevalence of COVID-19 by baseline characteristics. Logistic regression estimated unadjusted and sex-, age-, race- and comorbidity-adjusted odds ratios (AORs) for associations between SUD history, overdose history and outcomes. Results Of patients tested for COVID-19 ( n = 188 653), 2.7% ( n = 5107) had any history of SUD. Associations with hospitalization [AORs (95% confidence interval)] ranged from 1.78 (0.85–3.74) for cocaine use disorder (COUD) to 6.68 (4.33–10.33) for alcohol use disorder. Associations with ICU admission ranged from 0.57 (0.17–1.93) for COUD to 5.00 (3.02–8.30) for overdose. Associations with death ranged from 0.64 (0.14–2.84) for COUD to 3.03 (1.70–5.43) for overdose. Discussion Patients with histories of SUD and drug overdose may be at elevated risk of adverse COVID-19 outcomes.

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.…”

“…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 ].…”

Converging public health crises: substance use during the coronavirus disease 2019 pandemic

“…Overdoses may also influence development and progression of COVID-19. In New York, a prior nonfatal overdose was significantly associated with a positive COVID-19 test, hospitalization, and mortality [ 24 ▪▪ ]. Individuals in Canada who had a history of an overdose had an increased likelihood of having a risk factor for developing serious COVID-related health issues [ 25 ▪ ].…”

“…Some publications addressed the structural and individual-level barriers to care as well as the organizations’ response to these challenges. Although individuals with a history of an overdose or any substance use disorder could be more likely to experience a COVID-related admission to an ICU [ 24 ▪▪ ], persons who use substances may be unfamiliar with available resources, which could mitigate risk for harmful health consequences because of substance use in the pandemic. In three Norwegian cities, only a fourth (24.3%) of interviewees who use substances endorsed knowledge of COVID-19 services for persons who use drugs [ 26 ].…”