Editor in Chief
Coronavirus disease-2019 (Covid-19) disease, which is now a global health problem, might endanger some vulnerable groups including addicts at a higher risk. Apart from that fact, there are currently some misconceptions around the relationship between addiction and chance of becoming infected by new corona virus, with some supporting the idea of protective effect of addiction against Covid-19 disease. In this letter, we have attempted to make the situation clear by providing related evidence on the vulnerability of addicted people against this disease.
Covid-19 disease which belongs to coronavirus family, was first reported in Wuhan region of China in November 2019 and has now become an epidemic.1 There are many unknowns about this virus, but the thing which has not changed since the beginning of the epidemic is the susceptibility of some people to involvement with this virus. Studies on the disease have shown that some groups of people such as patients with cardiac disorders, respiratory diseases, elderly patients, and addicts are at higher risk of infection and mortality than others.2 A recent study by Saeedi et al. showed that the mortality rate of addicted patients due to Covid-19 infection is higher than their non-addict counterparts.3
Addiction is one of the social problems which affects health systems around the world including Iran’s and has been regarded as one of the social determinants of health (SDH) according to the World Health Organization (WHO) commission on SDH.4 Among narcotics, opium has been a popular plant in Iran for centuries and substance abuse is a social anomaly with multiple psychological and behavioral consequences causing numerous individual and social harms.5 Based on a previous study, about 2.8% and 9.0% of Iranian adults are addicted to opium, which reaches to 22.0% in some areas.6 This issue is significant from two aspects: first, living conditions of addicted people and lack of hygiene and second, the increase in the probability of getting the disease in this special group.
Furthermore, there has recently been a misconception in social media, community, and even a recently published paper3 on the protective effect of opium consumption against Covid-19 disease, which can lead to addiction of more people.
In contrast, most studies have shown that opium consumption is considered a risk factor for viral infections for a number of reasons, including higher risk for pulmonary infections because of prior cardio pulmonary comorbidities, mucociliary dysfunction, weakened immunity, special health seeking behavior coupled with insufficient access to health services, housing problems, and inability to use rehabilitation services.7
Among the above mentioned reasons, addicts’ pre-existing comorbidities expose them to higher risk of Covid-19 infection.8 Although, the possible mechanisms of virus pathogenicity are not well understood yet, Nabati et al. indicated that increased level of interleukin-6 (IL-6) taken from plasma of opium addicted patients leads to cytokine storm which is the common etiology of mortality in patients with Covid-19.9
To sum up, there is still need for further studies to determine the accuracy of this issue, but in light of the above, it seems that this social issue needs special attention including raising public awareness and information.
REFERENCES
- 1.Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924. doi: 10.1016/j.ijantimicag.2020.105924. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Farhoudian A, Baldacchino A, Clark N, Gerra G, Ekhtiari H, Dom G, et al. COVID-19 and substance use disorders: Recommendations to a comprehensive healthcare response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper. Basic Clin Neurosci. 2020;11(2):133–50. doi: 10.32598/bcn.11.covid19.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Saeedi M, Omrani-Nava V, Maleki I, Hedayatizadeh-Omran A, Ahmadi A, Moosazadeh M, et al. Opium Addiction and COVID-19: Truth or false beliefs. Iran J Psychiatry Behav Sci. 2020;14(2):e103509. [Google Scholar]
- 4.Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, et al. The commission on social determinants of health: Tackling the social roots of health inequities. PLoS Med. 2006;3(6):e106. doi: 10.1371/journal.pmed.0030106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Babaei HA, Ramezankhani A, Barekati H, Vejdani M, Shariatinejad K, Panahi R, et al. Prevalence of substance abuse among dormitory students of Shahid Beheshti University of Medical Sciences, Tehran, Iran. Int J High Risk Behav Addict. 2015;4(2):e22350. doi: 10.5812/ijhrba.22350v2. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Aflatoonian MR, Sharifi I, Aflatoonian B, Divsalar K. Changes in the pattern of opium addiction in Bam after the earthquake. Report of Health Care. 2015;1(3):104–8. [Google Scholar]
- 7.Ziaee M, Hajizadeh R, Khorrami A, Sepehrvand N, Momtaz S, Ghaffari S. Cardiovascular complications of chronic opium consumption: A narrative review article. Iran J Public Health. 2019;48(12):2154–64. [PMC free article] [PubMed] [Google Scholar]
- 8.Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779–88. doi: 10.1016/j.dsx.2020.05.035. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Nabati S, Asadikaram G, Arababadi MK, Shahabinejad G, Rezaeian M, Mahmoodi M, et al. The plasma levels of the cytokines in opium-addicts and the effects of opium on the cytokines secretion by their lymphocytes. Immunol Lett. 2013;152(1):42–6. doi: 10.1016/j.imlet.2013.04.003. [DOI] [PubMed] [Google Scholar]