Substance Use Disorders and COVID-19 Vaccine Response | Addiction Medicine | JAMA | JAMA Network
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Health Agencies Update
November 23/30, 2021

Substance Use Disorders and COVID-19 Vaccine Response

JAMA. 2021;326(20):2000. doi:10.1001/jama.2021.19977

Among individuals fully vaccinated against COVID-19, those with substance use disorders (SUD) may have a higher risk of becoming infected with SARS-CoV-2, according to a recent study led by researchers at the National Institute on Drug Abuse and Case Western Reserve University.

People with substance use disorders may be at higher risk of SARS-CoV-2 infection even if they’re fully vaccinated.

Analyses conducted earlier in the pandemic, before vaccines became available, found that people with SUD had an increased risk of becoming infected with SARS-CoV-2 and were more likely to be hospitalized and die of COVID-19.

The vaccine clinical trials didn’t specifically include people with SUD, many of whom have compromised immune systems because of their drug use and comorbidities. Researchers hypothesized that people with SUD might not respond as well to immunization as individuals with healthy immune systems.

The authors of the new study analyzed electronic health records for nearly 580 000 people in the US, approximately 30 000 of them with an SUD diagnosis, who were fully vaccinated between December 1, 2020, and August 14, and hadn’t been infected with SARS-CoV-2 before their vaccination.

The study found that the risk of SARS-CoV-2 infection in vaccinated people with SUD ranged from 6.8% among those with tobacco use disorder to 7.8% for cannabis use disorder—significantly higher than the 3.6% risk among vaccinated individuals without SUD. After accounting for demographics and vaccine brand, infection risk was still significantly higher among vaccinated people with SUD, except for those with tobacco use disorder, than among vaccinated individuals without SUD.

This was largely due to the higher prevalence of comorbidities and adverse socioeconomic determinants of health among people with SUD, compared with people who don’t have SUD, the researchers wrote in World Psychiatry. Unlike their previous study conducted early in the pandemic, the authors didn’t find significant age, gender, or racial and ethnic disparities in COVID-19 risk among vaccinated people with SUD.