The National Institutes of Health recently announced that vaccinated individuals with substance use disorders may be at higher risk for coronavirus disease (COVID-19) breakthrough infections and severe outcomes, including hospitalization and death.
Christopher Meaden, assistant professor in the Department of Emergency Medicine at Rutgers New Jersey Medical School (NJMS), said that while fully vaccinated patients with substance use disorders have a low overall risk of breakthrough infection, they are at higher risk when compared to vaccinated patients without a substance use disorder.
The reason for this, he said, might be because individuals with a substance abuse disorder are extremely vulnerable to new pathogens, especially as an individual’s immune system changes after consuming psychoactive drugs or alcohol.
For instance, the study specifically showed that individuals with cannabis use disorder are at the most risk of breakthrough infections, which is likely to be related to the changes to the immune system caused by cannabis, Meaden said.
Mehruba Parris, assistant professor in the Department of Emergency Medicine at Rutgers NJMS, said the findings for individuals with cannabis use disorder were especially significant since those patients were typically younger and had fewer comorbidities.
“Seven (percent) of vaccinated people with substance use disorders had a breakthrough infection during the study, compared with 3.6 (percent) of vaccinated people without substance use disorders,” according to the announcement. “The risk of breakthrough infection varied slightly among people with different substance use disorders, ranging from 6.8 (percent) for people with tobacco use disorder to 7.8 (percent) for those with cannabis use disorder.”
Meaden said that patients with substance use disorders may also have co-occurring health conditions that exacerbate their risk of virus infection, with lifestyle habits, such as poor hygiene, also potentially playing a role in infection likelihood.
Some specific health problems that may increase these individuals' risk include various cardiovascular, cerebrovascular, immune, hematological, pulmonary, metabolic, oncological, hepatic, renal, infectious, neurological and psychiatric issues, Parris said.
Many individuals with substance use disorder are also likely to have mental health disorders, housing insecurity and lack of access to healthcare, all of which contribute to a higher risk of infection, she said. Other socioeconomic conditions that could lead to increased risk include facing employment issues, physical disability and food insecurity.
“In general, those with other comorbid conditions and adverse socioeconomic determinants of health tend to be at higher risk of contracting COVID-19 and doing worse with COVID-19 so it is not surprising that it is the case in the fully vaccinated as well, even though as significantly lower rates,” Parris said.
She said that continued education and funding of substance use disorder programs would help combat this issue. Parris and Meaden both said they support continued vaccination to reduce rates of COVID-19 virus infection, as the study showed that rates of breakthrough infection are low even among this population of individuals with substance use disorders.
“It should be clear that we should continue to vaccinate this already vulnerable subset of patients in an effort to prevent severe disease due to (COVID-19),” Meaden said. “Our strategies should include offering vaccinations, if able, through safety net medical facilities that serve our most vulnerable patient populations, like emergency departments.”
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October 25, 2021 at 11:51AM
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