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As we grapple with the impact of COVID-19 nationally and internationally, we should be aware of the possibility that it could have a greater impact on individuals with substance use disorders (SUDs).

In particular, COVID-19 could be especially dangerous to those who smoke or vape tobacco or marijuana because of its attack on the respiratory system. Individuals with opioid or methamphetamine use disorder may also be vulnerable due to the effects those drugs have on respiratory and pulmonary health.

Additionally, individuals with SUDs are more likely to experience homelessness or incarceration than the general population, and these circumstances pose unique challenges regarding the transmission of the virus. All these possibilities should be kept in mind as developments continue for this emerging health threat.

COVID-19 Overview

SARS-CoV-2, the virus that causes COVID-19, is believed to have been transmitted from other mammals to humans in Wuhan, the capital of China’s Hubei province, in late 2019. It attacks the respiratory system and appears to have a higher fatality rate than seasonal influenza, although the exact fatality rate is still unknown.

Thus far, serious illness and death from COVID-19 seems concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, heart disease, and respiratory conditions. Co-occurring conditions have been found to worsen the prognosis for patients with other coronaviruses that affect the respiratory system, such as those causing SARS and MERS.

COVID-19, Tobacco and Marijuana

Because of the impact of COVID-19 on the respiratory system, it is reasonable to be concerned that compromised lung function or disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), cardiovascular disease and respiratory disease, could put individuals at risk for serious complications. According to data from the Chinese Center for Disease Control and Prevention, the case fatality rate for COVID-19 was 6.3 percent for those with chronic respiratory disease compared to 2.3 percent overall.

Like smoking, vaping may also harm lung health. Emerging evidence suggests that exposure to aerosols from e-cigarettes harms lung cells and diminishes the ability to respond to infection. While data thus far is preliminary, it does highlight the need for further research to clarify of the role of underlying illnesses and other factors in the susceptibility to COVID-19.

COVID-19, Opioid and Methamphetamine Addiction

Since opioids act in the brainstem to slow breathing, their use can put individuals at risk of life-threatening or fatal overdoses and may cause harmful decreases in blood oxygen levels. Lack of oxygen can be especially damaging to the brain if low levels persist. Because of this, chronic respiratory disease is known to increase overdose mortality risk for individuals taking opioids, and diminished lung capacity from COVID-19 could similarly endanger this population.

In addition, the increased prevalence of methamphetamine use in our country may have implications for the COVID-19 pandemic. Because methamphetamine constricts blood vessels, one of the factors contributing to pulmonary damage and hypertension, a history of use may put individuals diagnosed with the virus at greater risk for adverse effects.

COVID-19, Healthcare and Environment

Individuals with SUDs frequently struggle with access to healthcare, housing security, and incarceration. If hospitals and clinics are pushed to capacity, individuals with addiction – who are already underserved and stigmatized by the healthcare system – may experience even greater barriers to COVID-19 treatment.

Social distancing, self quarantining, and other public health measures may also disrupt access to injection services, medications, and other supports necessary for individuals with SUDs. And homelessness and incarceration can expose individuals to environments with close contact to others who may also be at higher risk for infection.

COVID-19, SUD and the Future

Right now, we know very little about the impact of COVID-19 and even less about its implications for SUDs. However, based on past experience, we can make educated guesses that individuals with compromised health due to SUDs could find themselves at greater risk for contracting COVID-19 and facing serious complications as a result.

We must ensure that SUD patients are not discriminated against if the rise in COVID-19 cases places added burden on our healthcare system. And we must strive to confront the major health challenges of substance use disorders – and the implications of rising COVID-19 infections – with compassion and integrity.