COVID-19 & Substance Use

Researchers have observed increases in substance use and drug overdoses in the United States since the COVID-19 pandemic was declared a national emergency in March 2020. The COVID-19 pandemic also presents unique challenges for people with substance use disorders and those in recovery. For example, people with substance use disorders are at increased risks for poor COVID-19 outcomes. Because of these factors, NIDA plays an important role in the federal response to the COVID-19 pandemic.

More on COVID-19, mental health, and substance use:

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 their 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.

    In October 2021, an analysis of electronic health records of nearly 580,000 fully vaccinated people in the United States found that the risk of SARS-CoV-2 (the virus that can cause COVID-19) breakthrough infection among vaccinated patients with substance use disorders was low overall, but higher than the risk among vaccinated people without substance use disorders. During the study, 7% of vaccinated people with substance use disorders had a breakthrough infection, compared with 3.6% of vaccinated people without substance use disorders. The study also found that co-occurring health conditions and adverse socioeconomic factors, which are more common in people with substance use disorders, appeared to be largely responsible for the increased risk of breakthrough infections.2 Read more about these findings.

    Should people with substance use disorders receive a COVID-19 vaccine booster shot?

    The Centers for Disease Control and Prevention recommends COVID-19 vaccine booster shots for people who meet certain criteria. These include some people with underlying medical conditions, including substance use disorders.

    Visit the CDC COVID-19 Booster Shot page for the latest guidance on COVID-19 vaccine booster shots.

    Find a COVID-19 vaccine or COVID-19 vaccine booster shot near you at Vaccines.gov. Learn more about COVID-19 vaccination and substance use disorders from the Centers for Disease Control & Prevention. See "Can people who use substances or who have substance use disorders receive a COVID-19 vaccine?

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

    Yes. Substance use disorders are considered underlying medical conditions that increase the risk of serious, life-threatening complications from COVID-19. COVID-19 vaccinations are recommended for and can be administered to most people with underlying conditions. 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.

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

    Yes. Opioid use disorders are considered underlying medical conditions that increase the risk of serious, life-threatening complications from COVID-19. COVID-19 vaccinations are recommended for and can be administered to most people with underlying conditions. For most people, it is not recommended to avoid, discontinue, or delay medications for underlying medical conditions around the time of COVID-19 vaccination.

    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.3,4 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.

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

    Provisional data show that drug overdoses have accelerated during the COVID-19 pandemic. More than 93,000 drug overdose deaths were estimated to have occurred in the United States in 2020, the highest number of overdose deaths ever recorded in a 12-month period and a nearly 30% increase from 2019, according to recent provisional data from the Centers for Disease Control and Prevention.

    This increase follows a steady rise in overdose deaths in the United States since at least the 1980s.1 Since 2016, drug overdose deaths have been driven largely by fentanyl and similar synthetic opioids. Experts note that factors related to the pandemic—such as social isolation and stress, people using drugs alone, an overall increase in rates of drug use, and decreased access to substance use treatment, harm reduction services, and emergency services—likely exacerbated these trends, though more research is needed to better understand this relationship.3

    Are people using drugs more during the COVID-19 pandemic?

    Data indicated there have been large increases in many kinds of drug use in the United States since the national emergency was declared in March 2020. Researchers have found increases in the number of positive urine drug screens ordered by health care providers and legal systems. In these reports, positive screens for fentanyl, cocaine, heroin, and methamphetamine have all increased from previous years.4,5 Studies in the United States and other countries also suggest many people increased their use of alcohol and cannabis (marijuana), especially people with clinical anxiety and depression and those experiencing COVID-19-related stress.6,7,8

    Social isolation and pandemic-related stress are likely contributing factors to increases in substance use and poor substance use outcomes,9,10,11,12 though further research is needed to understand the relationship between the COVID-19 pandemic and patterns of substance use. NIDA continues to support and conduct research to better understand and respond to pandemic-related risk factors for substance use and substance use disorders.

    Among adolescents, rates of cannabis use and binge drinking during the COVID-19 pandemic did not change significantly from prior years, according to a nationally representative survey of 12th graders in the United States conducted between mid-July and mid-August 2020. The same study found nicotine vaping in high school seniors declined somewhat between 2019 and 2020. Another study found 10-14-year-olds had similar overall rates of drug use before and during the first six months of the COVID-19 pandemic. Learn more about youth substance use during the COVID-19 pandemic.

    Are people at greater risk of developing substance use disorders during the COVID-19 pandemic?

    Data on how many people have developed substance use disorders in 2020 in the United States have not yet been released. However, addiction scientists have long understood that stress, trauma, mental illnesses, and other types of mental distress make people more vulnerable to developing substance use disorders.9,10,11,12,13,14 Since the pandemic began, public health officials have noted increased reports of mental distress for many populations, including individuals with no history of mental illness, younger adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers.15,16,17 NIDA continues to support and conduct research to better understand and respond to pandemic-related risk factors for substance use and substance use disorders.

    Learn more and find resources for support under:

    How is the COVID-19 pandemic 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.

    How is the COVID-19 pandemic impacting young people and their substance use?

    The COVID-19 pandemic has created significant disruptions in the lives of many children and adolescents around the world, and studies have shown many young people may be experiencing greater rates of anxiety, depression, and other mental health problems.18

    NIDA is supporting research to better understand how the pandemic is affecting substance use and other health outcomes among young people, including the Adolescent Brain Cognitive DevelopmentStudy (ABCD Study®), the HEALthy Brain Child Development (HBCD) Study, and the annual Monitoring the Future (MTF) survey.

    The ABCD Study®, launched in 2018, is the largest long-term study of brain development and child health in the United States. The study, led by NIDA and supported by nine other NIH institutes and centers, follows more than 10,000 children beginning at ages 9-10 with biennial brain scans and annual neurocognitive testing. The study also involves regular biospecimen collection and questionnaires about physical and mental health, substance use, culture and environment, lifestyle, and other factors. During the pandemic, researchers added monthly questionnaires to ask about COVID-related health outcomes, attitudes, and how the pandemic is affecting school attendance and activities, family life, sleep, daily routines, physical activity, mental health, screen time, experiences of racism and discrimination, and coping behaviors. A survey of 7,800 ABCD participants aged 10-14 found the overall rate of drug use among these youth remained relatively stable before and during the first six months of the COVID-19 pandemic. Learn more about these findings.

    As part of the NIH Helping to End Addiction Long-Term (HEAL) Initiative, NIDA leads the HEALthy Brain and Child Development (HBCD) Study which will follow children and their mothers from the prenatal period through ages 9-10 to better understand the impact of maternal substance use, environment, and related factors on child development. In the pilot phase of the HBCD study, pregnant women participated in studies to examine the impact of the pandemic on their health and well-being. In a smaller group, researchers used neuroimaging techniques to compare the brains of babies born to women who tested positive for SARS-CoV-2 (the virus that causes COVID-19) to babies born prior to the pandemic or to women who were SARS-CoV-2-negative. Both the ABCD and HBCD studies will track multiple health measures, including those related to substance use and COVID-19, in their respective participants through the pandemic and beyond.

    Preliminary data from the MTF survey (collected between mid-July and mid-August 2020) suggest high school seniors’ rates of cannabis use and binge drinking during the COVID-19 pandemic did not change significantly from prior years, though teens perceived them as less available. Researchers also found nicotine vaping in high school seniors declined somewhat between 2019 and 2020. Learn more about these findings. Additional data from the MTF survey on youth substance use during 2020 are anticipated in late 2021.

    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)
    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-19.5 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.6 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-19.5

    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.7 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.

    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.

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    References

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    2. L Wang, QQ Wang, PB Davis, et al. Increased risk for COVID-19 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021. World Psychiatry. DOI: 10.1002/wps.20921 (2021). 
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