COVID-19 & Substance Use

The COVID-19 pandemic presents unique challenges for people with substance use disorders and in recovery. The following resources may help.

NIDA Director Nora D. Volkow, M.D., continues to discuss COVID-19 and substance use disorder on Nora’s Blog (en español) and through her scientific publications.

    FAQs on COVID-19 and Substance Use

    Are people who use substances or have an addiction, or substance use disorder, at greater risk for contracting COVID-19?

    Yes. While research on how substance use affects susceptibility to COVID-19 is evolving, smoking and substance use disorders are on a list of underlying medical conditions associated with high risk for severe COVID-19 illness compiled by the Centers for Disease Control and Prevention.

    In September 2020, an analysis of electronic health records from more than 73 million patients at 360 U.S. hospitals found that while people with substance use disorders made up only 10.3% of the sample overall, they accounted for 15.6% of patients diagnosed with COVID-19. Overall, people with a previous diagnosis of a substance use disorder at any point in lifetime were 1.5 times more likely to have COVID-19 than those who did not. The study also found people with such a diagnosis were more likely to experience severe outcomes of COVID-19 than those without, including hospitalization (41% versus 30%) and death (9.6% versus 6.6%).[1] Read more about these findings.

    Can people who use substances or who have substance use disorders receive a COVID-19 vaccine?

    Yes, the Centers for Disease Control and Prevention encourage people with underlying medical conditions, which include substance use disorders, to be fully vaccinated against COVID-19 as soon as a vaccine becomes available to them. Most people aged 12 years and older can receive a free COVID-19 vaccination regardless of current drug use or a history of drug use. No safety issues have been reported linking substance use to adverse reactions to any of the COVID-19 vaccines available to consumers in the United States.

    Can people taking medications for opioid use disorder, such as methadone or buprenorphine, receive a COVID-19 vaccine?

    Yes. No safety issues have been reported linking medications for opioid use disorder to adverse reactions to any of the COVID-19 vaccines available to consumers in the United States. Experts recommend people taking medications for opioid use disorder receive a COVID-19 vaccine and continue their medications as directed by a healthcare professional.

    Do people with substance use disorders face challenges accessing COVID-19 vaccines?

    While data is still being collected on how well COVID-19 vaccines are reaching people with substance use disorders, healthcare systems have struggled to provide timely preventative care to this population in the past.[2] [3] As a result, government agencies and non-government organizations have developed programs to increase outreach to people with substance use disorders or in recovery.

    Learn more about one such initiative by visiting the COVID-19 Vaccine Navigator Initiative online or by calling 833-301-HELP (4357). This initiative is managed by the non-government organizations Addiction Policy Forum and the Foundation for Opioid Response Efforts, and is not affiliated with NIDA.

    Is COVID-19 of particular concern for those who smoke or vape?

    Yes. Smoking or vaping drugs—including tobacco/nicotine, marijuana, heroin, or crack cocaine—has been shown to worsen lung conditions like chronic obstructive pulmonary disease (COPD) and asthma, and chronic lung diseases can make a person more likely to get severely ill from COVID-19.[4] The Centers for Disease Control and Prevention report that being a current or former cigarette smoker can make you more likely to get severely ill from COVID-19. Using vaping devices (e-cigarettes) can expose the lungs to toxic chemicals,[1] but it is not clear if there is an increase for risk of contracting the virus that causes COVID-19 or if vaping leads to more severe symptoms.

    According to a September 2020 analysis of electronic medical records, hospital patients who had received a diagnosis of tobacco use disorder in the past year were 8.2 times more likely to have COVID-19 than those without.[1]

    Is COVID-19 of particular concern for people who use opioids or have an opioid use disorder?

    Very likely yes. Opioids act in the brainstem to slow breathing, increasing the risk for life-threatening overdose and long-term damage to the brain, heart, and lungs.[5] Because of these negative impacts on heart and lung health, people who use opioids at high doses may be more susceptible to COVID-19, and their illness may be more severe.

    According to a September 2020 analysis of electronic medical records, hospital patients who had received a diagnosis of opioid use disorder in the past year were 10.2 times more likely to have COVID-19 than those without.[1] More research is needed to better understand the relationship between opioid use and COVID-19.

    Could using methamphetamine, cocaine and other stimulants put people at risk for COVID-19?

    Very likely yes. The use of stimulants such as methamphetamine, cocaine, and amphetamine constricts the blood vessels and may increase the risk for stroke, heart attacks, abnormal heart rhythm, seizures, and other conditions that may lead to more severe heart or lung damage in someone with COVID-19.[4]

    According to a September 2020 analysis of electronic medical records, hospital patients who had received a diagnosis of cocaine use disorder in the past year were 6.5 times more likely to have COVID-19 than those without.[1] More research is needed to better understand the relationship between stimulant use and COVID-19.

    Do people with substance use disorders have other risks associated with COVID-19?

    Yes. A high percentage of individuals with substance use disorders experience homelessness, and vice versa.[6] Among countless other difficulties, people who experience homelessness and housing instability are at increased risk for COVID-19 because of higher rates of underlying health conditions and community spread in homeless shelters. The same is true of incarceration. More than half of incarcerated people in the United States have substance use disorders, and prison populations are at a higher risk of contracting COVID-19. Additionally, during times of high COVID-19 hospitalizations, access to healthcare can be limited in certain areas, and people with addiction may not be able to get care when they need it.

    How is the COVID-19 crisis impacting people in treatment for substance use disorders and those currently in recovery?

    People in treatment for substance use disorders face unique challenges during the pandemic. Physical distancing, quarantine, and other public health measures have disrupted access to medication and other support services for many people. For example, people with opioid use disorder who rely on methadone dispensed at a clinic may be unable to access this daily medication while physically distancing. In response, federal agencies have taken steps to expand access to needed medications during the pandemic. These include allowing people with opioid use disorder to begin treatment with buprenorphine without an initial in-person doctor visit and allowing some people on a stable methadone treatment regimen to obtain 14-28 days of take-home doses. NIDA Director Dr. Nora Volkow discusses these changes in a September 2020 blog post.

    For those in recovery from a substance use disorder, social support is crucial, and social isolation is a risk factor for continued substance use (relapse). Physical distancing measures and quarantine may be especially difficult for people in recovery because they limit access to meetings of peer-support groups and other sources of social connection. Although in-person recovery supports may be limited during the pandemic, virtual meetings and telehealth counseling have expanded and may be useful for some. Learn more about COVID-19 and recovery.

    Has the COVID-19 pandemic impacted the frequency of drug overdose?

    Provisional data shows that drug overdoses have accelerated during the COVID-19 pandemic. Nearly 92,000 drug overdose deaths occurred in the United States from November 2019 to October 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recent provisional data from the Centers for Disease Control and Prevention.

    What should I do during this pandemic if I have or am concerned about having a substance use disorder?
    • Get vaccinated to protect yourself from COVID-19. Learn more about COVID-19 vaccination from the Centers for Disease Control and Prevention.
    • Avoid contracting COVID-19 by following COVID-19 guidance.
    • Call your doctor if you experience symptoms of COVID-19. Individuals with an SUD may be at higher risk for serious effects.
    • If you are in treatment for substance use, maintain contact with your provider. Learn how COVID-19 public health measures impact your treatment to ensure you continue with care.
    • If you are in crisis, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free, confidential and available 24 hours a day, seven days a week. Those with hearing impairments can contact the Lifeline via TTY at 1-800-799-4889.
    • It is normal to experience stress during this difficult time, but stress can also increase substance use. Effective treatment, positive coping strategies and virtual recovery resources can reduce the impact of stress and fear and alleviate anxiety, depression, and other difficult emotions.
    • Consider connecting to supportive resources, including virtual recovery resources, such as those listed here:
      • Substance Abuse and Mental Health Services Administration (SAMHSA)
        • FindTreatment.gov and 1-800-662-HELP (4357) to connect to one of thousands of state-licensed providers who specialize in treating substance use disorders, addiction, and mental illness.
        • Virtual Recovery Resources for Substance Use and Mental Illness includes links to online meetings and recovery support resources offered by various mutual help groups and other organizations, as well as information on setting up a virtual meeting.
      • National Institute on Alcohol Abuse and Alcoholism (NIAAA)
    How do I help a loved one who is struggling with substance use, or who is in recovery, during this difficult time?
    Experiencing stress related to the COVID-19 pandemic may be especially hard for people with a substance use disorder. Those in recovery may face heightened urges to use substances and could be at increased risk for starting to use substances again (relapse).
    • If your loved one is in crisis, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255),or text the Crisis Text Line (text HELLO to 741741). Both services are free, confidential and available 24 hours a day, seven days a week. Those with hearing impairments can contact the Lifeline via TTY at 1-800-799-4889.
      • Contact social media outlets directly if you are concerned about a friend’s social media posts.
      • Dial 911 in an emergency.
    • If you know someone who is experiencing or recovering from a substance use disorder, now may be a good time to reach out to them to see how they are and to remind them that they are loved.
    • You can also encourage your loved one to use effective coping strategies to reduce the impact of stress and fear, and alleviate anxiety, depression, and other difficult emotions.
    • If your loved one is increasing their use of substances or decreasing treatments during this pandemic, help them connect to supportive resources, including virtual recovery resources:
      • Substance Abuse and Mental Health Services Administration (SAMHSA)
        • FindTreatment.gov and 1-800-662-HELP (4357) to connect to one of thousands of state-licensed providers who specialize in treating substance use disorders, addiction, and mental illness.
        • Virtual Recovery Resources for Substance Use and Mental Illness. Includes links to online meetings and recovery support resources offered by various mutual help groups and other organizations, as well as information on setting up a virtual meeting.
      • National Institute on Alcohol Abuse and Alcoholism (NIAAA)
    Image
    This scanning electron microscope image shows SARS-CoV-2 (round gold objects) emerging from the surface of cells cultured in the lab
    Courtesy of NIAID
    This scanning electron microscope image shows SARS-CoV-2 (round gold objects) emerging from the surface of cells cultured in the lab. SARS-CoV-2 is the virus that causes COVID-19. Image captured and colorized at NIAID's Rocky Mountain Laboratories in Hamilton, Montana.

    Guidance for Health Professionals

    Guidance for Researchers

    Justice System Resources

    References

    1. Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Molecular Psychiatry. 2020;26(1):30-39. doi:10.1038/s41380-020-00880-7
    2. Benjamin-Johnson R, Moore A, Gilmore J, Watkins K. Access to Medical Care, Use of Preventive Services, and Chronic Conditions Among Adults in Substance Abuse Treatment. Psychiatric Services. 2009;60(12):1676-1679. doi:10.1176/ps.2009.60.12.1676
    3. Chitwood DD, Sanchez J, Comerford M, McCoy CB. Primary Preventive Health Care Among Injection Drug Users, Other Sustained Drug Users, and Non-Users. Substance Use & Misuse. 2001;36(6-7):807-823. doi:10.1081/ja-100104092
    4. Volkow ND. Collision of the COVID-19 and Addiction Epidemics. Annals of Internal Medicine. 2020;173(1):61-62. doi:10.7326/m20-1212
    5. White JM, Irvine RJ. Mechanisms of fatal opioid overdose. Addiction. 1999;94(7):961-972. doi:10.1046/j.1360-0443.1999.9479612.x
    6. Polcin DL. Co-occurring substance abuse and mental health problems among homeless persons: Suggestions for research and practice. Journal of Social Distress and the Homeless. 2015;25(1):1-10. doi:10.1179/1573658x15y.0000000004