People who are fully vaccinated against COVID-19 and have a substance use disorder (SUD) appear to be at higher risk for breakthrough infections than people without an SUD, according to a report in World Psychiatry.
The risk of breakthrough infection for people with SUDs ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder. The risk of breakthrough infections in vaccinated people without an SUD was 3.6%.
“[T]he overall risk of COVID-19 among vaccinated people with substance use disorders is very low,” NIDA Director Nora D. Volkow, M.D., one of the study authors, said in a news release. “We must continue to encourage and facilitate COVID-19 vaccination among people with substance use disorders, while also acknowledging that even after vaccination, this group is at an increased risk and should continue to take protective measures against COVID-19.”
The researchers analyzed de-identified data from electronic health records for 30,183 fully vaccinated patients with history of SUD and 549,189 patients without SUD between December 2020 and August 2021—a period that included the Delta variant outbreak. Among the fully vaccinated population with an SUD, 7,802 patients had a diagnosis of alcohol use disorder, 2,058 of cannabis use disorder, 1,011 of cocaine use disorder, 2,379 of opioid use disorder, and 21,941 of tobacco use disorder.
The risk of breakthrough infection for all five SUDs was significantly higher than for vaccinated individuals without an SUD: alcohol use disorder (7.2%), cannabis use disorder (7.8%), cocaine use disorder (7.7%), opioid use disorder (7.1%), and tobacco use disorder (6.8%). Additionally, the rates of hospitalization and death for SUD patients with a breakthrough infection were 22.5% and 1.7%, respectively, compared with 17.5% and 1.1%, respectively, in patients without an SUD who had a breakthrough infection.
When the researchers matched individuals with and without an SUD for lifetime comorbidities and adverse socioeconomic determinants of health, they found there was no difference in the risk of breakthrough infections between these populations, except for patients with cannabis use disorder, who remained at increased risk.
“These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID-19 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non-SUD individuals,” the study authors wrote. “The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.”
For related information, see the Psychiatric News article “SUD Patients More Susceptible to COVID-19, Adverse Outcomes.”
(Image: iStock/SDI Productions)
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