Table 1.
Summary of results from included articles
| Author | Pub. Date | Article/Study Type | Substance studied | Risks of infection | Risks of adverse outcomes |
| Melamed [2▪▪] | Jul-20 | Review/Commentary | - Multiple substances | - Socioeconomic barriers increase risk of virus exposure- Drug procurement can increase exposure | - High rates of smoking-associated lung disorders increase risk of adverse outcomes- Chronic SU causes immune dysfunction- SU increases risk of illness complications |
| Wang [3▪▪] | Jun-20 | Retrospective Case-Control Study | - Multiple substances | - Pts with SUD have significantly higher rates of COVID-19 infections; OUD pts had highest risk- Pharmacological effects of substances can increase rates of COVID-19 | - SUD pts had higher rates of asthma, kidney disease, COPD, diabetes, cancer, HIV, chronic liver disease, cardiovascular diseases- Hospitalization rates were much higher- Pharmacological effects of substances can increase COVID-19 adverse outcomes |
| Volkow [11▪] | Apr-20 | Review/ Opinion | - Opioid use disorder | - SUD pts are at increased risk of infection due to housing instability, incarceration, reduced access to healthcare and recovery support services- Prisons and homeless shelters are particularly high-risk environments- Social distancing/ quarantine increase sharing of drug equipment, overdose risk | - Severe COVID-19 infection occurs in those who are elderly and in those who are immunocompromised- Risk is increased in those with underlying health conditions like diabetes, cancer, heart, and respiratory diseases. These underlying diseases are common in those with SUD- SUD pts delay care and face stigma from medical systems |
| Dubey [12▪] | Jun-20 | Literature Review | - Multiple substances | - SUD pts at increased risk due to preexisting comorbid conditions, mucociliary dysfunction, immune dysfunction, socioeconomic barriers, poor healthcare access- Smoking increases expression of ACE which increases virion entry- SUD increased chance of high-risk behaviors like sharing needles etc., | - SUD pts delay care and face stigma from medical systems- Some data that nicotinic receptors modulate immune response and decrease risk of symptomatic infection- Increased risk of having premorbid conditions that increase risk of adverse outcomes- SUD pts have immune system dysfunction, vitamin deficiency, and increased risk of aspiration pneumonia- OU: respiratory depression and hypoxemia- MU: increased lung injury, pulmonary HTN |
| Schimmel [13▪] | Jul-20 | Review/Commentary | - Opioid use disorder | - Chronic OU causes immune dysfunction which increases risk of infection | - Respiratory toxicity from opioid use can worsen outcomes from lung infection |
| Wei [7] | Jul-20 | Literature Review | - Multiple substances | - Pts with SUD are vulnerable due to socioeconomic barriers | - Increased risk of HIV and hepatitis C; can cause immunosuppression- Smoking increases risk of COPD; leads to complications of COVID-19- OU: respiratory depression, hypoxemia- MU: increased lung injury, pulmonary HTN- Various substances have direct impacts on immune system function increasing risk of adverse outcomes from infection |
| Enns [14] | Sep-20 | Evidence-Informed Policy Brief | - Multiple substances | - Changes in SU patterns can be barriers to infection reduction- SU paraphernalia sharing increases risk of transmission | |
| Boschuetz [15] | Sep-20 | Online Survey | - Alcohol use disorder | - AU increases risk of medical comorbidities – increased risk of adverse outcomes | |
| Valecillo [8] | Oct-20 | Observational Study | - Multiple substances | - High risk behaviors (obtaining substances, sharing drug equipment, etc.) increase risk of exposure- Socioeconomic barriers (living in shelters, inability to maintain quarantine) can increase risk of transmission | - People with SUD have increased prevalence of cardiovascular and respiratory diseases, obesity, cirrhosis, chronic heart disease, diabetes, renal disease, hypertension, cancer which increase complications and mortality- Risk of hospitalization due to pneumonia was lower - attributed to lower median age |
| Rubin [16] | Oct-20 | Review/Commentary | - Multiple substances | - OUD: increased risk of COVID-19- SUD pts more likely to develop COVID-19 (AOR 8.7) | - People with SUD were more likely to be hospitalized and die from COVID-19 |
| Baillargeon [9▪] | Nov-20 | Matched Cohort Study | - Multiple substances | - Higher rates of infection due to homelessness, poor living conditions, having poor access to healthcare | - SUD increases risk of immunosuppression; increases risk of infection, adverse reactions- HTN, COPD, ischemic and cardiovascular disease increases risk of poor outcomes- Increased risk of adverse outcomes due to increased ACE expression- Prolonged alcohol use linked to mucociliary dysfunction, respiratory disease |
| Allen [10] | Dec-20 | Retrospective Review | - Multiple substances | - Pts with SUDs: higher risk of critical illness |
ACE, angiotensin-converting enzyme; AU, alcohol use; HTN, hypertension; MU, methamphetamine use; OU, opioid use; OUD, opioid use disorder; pts, patients; SU, substance use; SUD, substance use disorder.