Addicted hit harder by COVID-19, nationwide study shows; doctors urged to make 'action plans'

• Hospitalizations of people with COVID-19 plus addiction were at 40.1% vs. 30.1% without addiction.
• Deaths of those with COVID-19 and addiction were at 9.6% compared to 6.6% for those without addiction.
• Types of substance use disorders studied : opioid, tobacco, alcohol, cannibis, cocaine.

Having an addiction to any substance – from tobacco to fentanyl – makes people more susceptible to getting COVID-19, new research shows.

The study forewarns those who care for people with addiction to have action plans in place "to help shield them from infection and severe outcomes."

"That's the main message," said Rong Xu, co-author of the study and a researcher and professor at Case Western Reserve University School of Medicine in Cleveland.

Xu and Dr. Nora Volkow, CEO of the National Institute on Drug Abuse (NIDA), released their findings this week. They analyzed 73 million electronic health records of unidentified patients across the United States. They found that people with a substance use disorder made up 10.3% of that population – and represented 15.6% of COVID-19 cases.

Those with an addiction diagnosis had worse COVID-19-related outcomes, too. They were more likely than those without to be hospitalized or to die.

The research further showed that people who are addicted to tobacco or opioids were most likely among those with substance use disorders (SUDs) to develop COVID-19. And Black people with SUDs were among the highest at risk.

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It's not the addiction disorder itself that puts people at risk for getting the illness associated with novel coronavirus, said Xu, contacted Tuesday in Cleveland.

Instead, the same health conditions that put people in other populations at risk are generally more prevalent in people with addictions. They include hypertension (which can increase the severity of COVID-19), obesity (or malnutrition), lung disease, poor liver function, and HIV.

Xu said that behavioral risks and socioeconomic status – living homeless, using buses instead of cars, living without ready access to soap and water, are more common among people who are in active addiction – although experts remind that people of any economic strata may have an addiction disorder. 

Chellie McLellan, CEO of the Center for Addiction Treatment in Cincinnati's West End, noted, "When someone is active in their addiction, care of self and the ability to manage in a healthy manner is a tremendous challenge." Whether the individual is a CEO or a janitor, she said, the chronic disorder, unmanaged, wreaks havoc on the person's life.

Since July 15, 203 people have been tested at the center as part of an assessment to enter a treatment program, and five were positive for COVID-19.

"We made sure that those folks had a safe place to go for quarantine," McLellan said.

The study's findings are unsurprising to Ohio and Kentucky treatment providers.

Dr. Mina "Mike" Kalfas, an addiction expert who practices at Journey Recovery Center in Crestview Hills, said the science is important despite the outcome being expected. And the risk of COVID-19 in substance users, particularly with those who are addicted, makes sense.

"They use in groups. They recover in groups," he said.

Like most treatment providers, Kalfas said, Journey Recovery keeps a close eye on its patients' general health. If patients show up with a fever or call in with  COVID-19 symptoms, they are given instructions on how to address it – and transportation to do so, if they need it.

Leaders at several treatment centers in Ohio said they're not seeing a boom in COVID-19 patients. But they're watching for it.

"Being aware of who your patient population is and being able to refer the addicted person for appropriate treatment is crucial," said Dr. Roberto Soria, medical director of Crossroads Cente in Corryville.

His center, which has 540 patients who receive methadone medication, has seen two positive cases. The clinic has protocols for any patient who tests positive or lives with someone else who has tested positive for COVID-19. Among them: A Crossroads caregiver will bring the person's methadone medication to them during quarantine.

State and federal guidelines also have made it easier to protect methadone patients. There is surveillance testing on staff, mask-wearing and social distancing within the clinics and temperature-taking outside the doors. 

The BrightView Health system, an addiction treatment provider with 22 clinics in Ohio and two in Kentucky, has seen few COVID-19 cases, said Navdeep Kang, chief clinical officer.

"We currently have 6,000-plus patients under the care of the BrightView health system.  We’ve seen positive cases, as one would expect amidst a pandemic, but the rate has been significantly less than 1%, and is notably lower than the community at-large."

The clinics' care model involves "close monitoring and intense treatment of patients," Kang said, which means COVID-19 symptoms would likely be spotted quickly.

But it isn't just people who already treat patients with addiction who need to be aware of their susceptibility to COVID-19, said Dr. O'dell Owens, president and CEO of Interact for Health, a nonprofit health organization in Norwood.

The authors of the NIDA study said their findings underscore the need to screen for, and treat, substance use disorders as part of the strategy for controlling the novel coronavirus pandemic.

That's partly why families and others close to people who are suffering from addiction disorders should be aware of the risk of COVID-19.

And, Owens said, all caregivers, from harm-reduction workers at needle exchanges to outreach workers and treatment providers, should be equipped to direct people to testing for COVID-19 and tell them specifically how to get medical help for it.

"It needs to be a holistic approach," Owens said.

The NIDA study was funded by the National Institutes of Health.