People Who Smoke and Use Drugs During COVID-19 Pandemic Face Unique Risks: NIDA

April 3, 2020 Updated: April 3, 2020

The serious health risks of COVID-19 pose unique challenges to people who smoke or are struggling with substance use disorders (SUD), according to Dr. Nora Volkow, director of National Institute on Drug Abuse (NIDA).

“Coronavirus disease 2019 (COVID-19) is causing untold challenges to health care and wider social structures,” Volkow wrote in an article in the Annals of Internal Medicine, noting that especially vulnerable are people who smoke or vape, use opioids, or have a history of drug abuse.

The risk from COVID-19 is elevated for people with underlying health conditions, including respiratory diseases, which are often associated with lung damage due to smoking.

“Data from the Chinese Center for Disease Control and Prevention have suggested that COVID-19 has a case fatality rate of 6.3 percent for individuals with chronic respiratory disease, compared with 2.3 percent overall,” Volkow wrote.

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Colorized scanning electron micrograph of an apoptotic cell (red) heavily infected with CCP virus particles (yellow), isolated from a patient sample. Image captured at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland, published on April 2, 2020. (NIAID)

She said people who vape nicotine or tetrahydrocannabinol, the active substance in marijuana, may also be at higher risk of complications from COVID-19.

“Preclinical studies show that e-cigarette aerosols can damage lung tissue, cause inflammation, and diminish the lungs’ ability to respond to infection,” she noted.

People who have a history of abusing opioids, methamphetamine, or other psychostimulants are also at risk due to compromised lung function, she said.

“At least 2 million persons in the United States have OUD [opioid use disorder], and more than 10 million misuse opioids,” Volkow wrote, adding, “these individuals may be at increased risk for the most adverse consequences of COVID-19.”

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An illustration image shows tablets of opioid painkiller Oxycodon, a prescription drug. (Eric Baradat//AFP via Getty Images)

She also noted that because of challenges to delivering care to people with substance use disorders, they may find it harder to get health care when they develop the new respiratory disease.

Social distancing measures, while important for reducing COVID-19 transmission, pose additional challenges to people struggling to recover from addiction.

“Social distancing will increase the likelihood of opioid overdoses happening when there are no observers who can administer naloxone to reverse them and thus when they are more likely to result in fatalities,” Volkow wrote.

Social isolation is also a risk factor for relapse into addiction.

“Persons who are isolated and stressed—as much of the population is during a pandemic—frequently turn to substances to alleviate their negative feelings. Those in recovery will face stresses and heightened urges to use substances and will be at greatly increased risk for relapse,” she wrote.

Volkow also argued emergency department physicians with increased caseloads amid the COVID-19 outbreak may also be less likely to initiate certain types of therapy for patients with OUD, or deprioritize care for them entirely.

“When hospitals are pushed to their capacity, there is added danger of persons with SUD being deprioritized for care if they present with COVID-19 symptoms,” Volkow noted.

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Firefighters help an overdose victim in Rockford, Illinois, on July 14, 2017. (Scott Olson/Getty Images)

While noting that much remains unknown about COVID-19, people who smoke, vape, or use certain drugs will be at increased risk for infection and its more severe consequences, she concluded.

She urged policymakers to consider new ways of meeting treatment and recovery needs of this population, including through measures ranging from enhancing virtual resources to minimizing office visits.

“Under no circumstances can we forget or marginalize persons with SUD during this new public health crisis,” she said.

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