USA: Collision of COVID-19 and Addiction Epidemic
COVID-19 and the addiction epidemic in the United States are on a collision course as those who are addicted to psychoactive substances are more vulnerable to the virus.
Persons who smoke or vape, use opioids, or have an alcohol or other substance use disorder (SUD) are at-risk groups for the current pandemic, writes Nora D. Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health.
Dr. Volkow lists three major aspects in which people with an substance use disorder are exposed to greater risk of COVID-19:
- Due to direct challenges to respiratory health, those with SUD may be especially susceptible to infection by the virus that causes COVID-19 and associated complications.
- People with SUD may also find it harder to get care due to gaps in the system for delivering services to these groups.
- Furthermore, people in recovery are also challenged due to physical distancing measures cutting off on connection which is crucial to recovery.
The US has been facing alcohol harm in epidemic proportions. As Movendi International reported, data from the National Council on Alcoholism and Drug Dependence (NCADD) shows that almost 20 million people in the United States suffer from an alcohol use disorder (AUD). This translates to 1 in 12 people suffering from AUD. Alcohol-related deaths have also been on the rise in the country in the past two decades.
Substance related health conditions increase COVID-19 risk
Risk factors for developing severe COVID-19 and death from the virus are,
- old age,
- being immunocompromised, and
- having underlying health conditions including diabetes, cancer, and heart and respiratory diseases.
Alcohol and other substance use can lead to many of these health conditions. Smoking is specifically tied to lung disease and decreased lung functioning. Data from the Chinese Center for Disease Control and Prevention have suggested that COVID-19 has a case fatality rate of 6.3% for individuals with chronic respiratory disease, compared with 2.3% overall.
People who vape are also at risk as they could have lung illnesses such as “popcorn lung” and e-cigarette or vaping product use–associated lung injury.
Compromised lung function from COVID-19 could also put at risk those who have opioid use disorder (OUD) or methamphetamine and other psychostimulant use disorders. Chronic respiratory disease increases risk for fatal overdose in those who use opioids therapeutically. In addition, slowed breathing due to opioids causes hypoxemia, which can lead to cardiac, pulmonary, and brain complications and, if severe, can result in overdoses and death. At least 2 million persons in the United States have OUD, and more than 10 million misuse opioids; these individuals may be at increased risk for the most adverse consequences of COVID-19.
Increased risks for persons with SUD
People living with these substance addictions face increased risks due to indirect factors as well. These include housing instability and incarceration, as well as reduced access to health care and recovery support services. A proportion of those with SUD experience homelessness. A high number of those incarcerated suffer from SUD as well. Both homeless shelters and prisons are at great risk for disease transmission during epidemics.
These people may face challenges in obtaining healthcare services. Stigma surrounding SUD can decrease the attention paid by healthcare workers for people with SUD. 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.
Physical distancing measures can increase the likelihood of overdoses and pose a challenge for those in recovery. Social support is crucial for persons trying to recover from SUD, whereas social isolation is a risk factor for relapse. However, many support services are now available virtually to help people through recovery during this period.
There’s also the risk of people turning to substances as an unhealthy coping mechanism to deal with stress and anxiety during the pandemic. The World Health Organizations (WHO) advises the public against this as harmful substances tend to increase anxiety and cause physical and mental health issues. Instead the WHO suggests healthy ways of dealing with the pandemic such as limiting information and supporting each other.
The current crisis poses increased risks and challenges for persons with substance use disorder. The health care system, policymakers, and researchers will have to accelerate finding new ways of meeting the treatment and recovery needs of this population. People with SUD must not be marginalized during this crisis and given the support and care they need.