Infectious Disease

Substance use disorder patients are at greater risk of breakthrough infections with SARS-CoV-2

October 12, 2021

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The risk of a breakthrough infection with SARS-CoV-2 was significantly higher in patients with a substance use disorder than in patients without one, according to a population-based cohort study.

Still, the researchers said the risk of breakthrough SARS-CoV-2 infection was low, even in people with substance use disorder (SUD).

“With the dominance of the Delta variant, declining immunity to vaccines and the high burden of comorbidities in the US population – six in ten adults have a chronic illness – it is important to understand the effectiveness of COVID-19 vaccines and the long-term effects of COVID- 19, ” Rong Xu, PhD, a professor of biomedical informatics and director of the Center for Artificial Intelligence in Drug Discovery at the Case Western Reserve School of Medicine, said in a press release.

Rong Xu

Xu and colleagues reviewed the data of 579,372 fully vaccinated adults in the United States who had not been diagnosed with COVID-19 prior to the administration of the vaccine. Of these, 30,183 had a SUD diagnosis. Of all patients, the majority received the Pfizer-BioNTech COVID-19 vaccine (75.6%), followed by the Moderna vaccine (21.1%), then the Johnson & Johnson vaccine (3.3%).

Xu and colleagues reported that the risk of a breakthrough infection with SARS-CoV-2 in patients with SUD varied depending on the substance. The overall risk was 6.8% in people with a tobacco use disorder, 7.1% in people with an opioid use disorder, 7.2% in people with an alcohol use disorder, 7.7% in people with a cocaine use disorder, and 7.8% in those with a cannabis use disorder. Conversely, the risk of breakthrough infection was 3.6% in those without SUD.

After adjusting the data for factors such as age, gender, ethnicity, and vaccine type, the breakthrough infection risk for cocaine use disorder (HR = 2.06; 95% CI 1.3-3.25) and cannabis use disorder (HR = 1.92; 95%) ) the highest. CI, 1.39-2.66). When the researchers compared all patients regardless of SUD status for “lifelong comorbidities and adverse socio-economic determinants of health”, only those with a cannabis use disorder were at higher risk of breakthrough infection (HR = 1.55; 95% CI 1.22-1 , 99).

The risk of hospitalization in the patients with SUD was 22.5% in the group with breakthrough infection and 1.6% in the group without breakthrough infection (RR = 14.4; 95% CI 10.19-20.42). The risk of death in patients with SUD was 1.7% in the group with breakthrough infection and 0.5% in the group without breakthrough infection (RR = 3.5; 95% CI 1.74–7.05).

“These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID-19 infection, and this is mainly due to their higher prevalence of comorbidities and adverse socio-economic determinants of health compared to non-SUD -Persons traced back, ”wrote the researchers.

Director of the National Institute of Drug Abuse and co-author of the study Nora D. Volkow, MD, noted in a press release that the vaccines were “highly effective” in patients with SUD and that the overall risk for COVID-19 was “very low” in fully vaccinated patients with SUD.

“We must continue to promote and facilitate COVID-19 vaccination in people with substance use disorders while recognizing that this group is at increased risk even after vaccination and should continue to take protective measures against COVID-19,” she said.

The results build on previous research published in Molecular Psychiatry on an association between SUD and COVID-19. In this study, researchers performed a retrospective review of electronic health records on 73,099,850 patients, most between the ages of 18 and 65, white and female. Of all the patients examined, 7,510,380 were diagnosed with SUD at some point in their life, 722,370 were diagnosed with SUD in the past year, 12,030 patients were diagnosed with COVID-19 and 1,880 patients were diagnosed with SUD and COVID at some point. 19 diagnosis diagnosed in their life.

The study showed that those diagnosed with SUD within the past year had a significantly increased risk of COVID-19 compared to those who were recently not diagnosed with SUD (adjusted OR [aOR] = 8.699; 95% CI, 8.411-8.997). Among patients diagnosed with SUD in the past year, African American patients were at significantly higher risk than Caucasian patients (aOR = 2.173; 95% CI, 2.01–2.349). The researchers wrote that their findings underscore the importance of screening and treating people with SUD as part of the strategy to fight the pandemic while ensuring that there are no disparities in access to health care.

References:

People with substance use disorders may be at higher risk for breakthrough SARS-CoV-2 infections. https://www.nih.gov/news-events/news-releases/people-substance-use-disorders-may-be-higher-risk-sars-cov-2-breakthrough-infections. Published October 6, 2021. Accessed October 7, 2021.

Wang L. et al. World Psychiatry. 2021; doi: 10.1002 / wps.20921.

Wang QQ et al. Mol psychiatry. 2021; doi: 10.1038 / s41380-020-00880-7.

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