Substance use disorders (SUDs) are among several health conditions that have been identified by the CDC as increasing a person’s risk for becoming severely ill from COVID-19. For this reason, it is especially important that people who use or are addicted to drugs become vaccinated. Because people with a history of experiencing stigma from the healthcare system due to an addiction may be hesitant, community leaders, healthcare providers, and others in the community must play a role in encouraging and facilitating vaccination for people with drug problems.
The increased risks of COVID-19 infection to people with SUD have been established by a growing amount of data: In an analysis of electronic health records of 73 million patients at U.S. hospitals, my colleagues and I found that people with SUDs, especially recent diagnoses, were at much higher risk than other people of having COVID-19 or suffering its worst outcomes; this was especially true for Black people. Studies in Korea and New York City found similar associations between SUDs and vulnerability to COVID-19, as did an analysis of data from 54,529 patients by researchers at the University of Texas Medical Branch, Galveston. Those researchers also suggested that chronic cardiovascular or respiratory conditions related to substance use may mediate this higher vulnerability.
Anyone over 12 years of age in the U.S. is now eligible to become vaccinated. Critically, people cannot be denied vaccination because of underlying health conditions, including substance use or a substance use disorder. Communities and health systems everywhere in the country are providing the vaccines free of charge, regardless of one’s immigration status or whether one has health insurance. Recipients cannot even be charged for the office visit, or any other fee. All three of the FDA-approved vaccines are considered equally effective and safe.
However, fears around vaccines, distrust of the government and the pharmaceutical industry, and misinformation are preventing many people from taking the potentially life-saving measure of getting vaccinated. Vaccine hesitancy could be especially a problem for people who may have experienced a history of mistreatment by healthcare for their drug use.
A survey conducted last year by the Addiction Policy Forum (APF) found that almost half of their sample of people affected by substance use disorders (actively using drugs, in treatment, or in recovery) expressed unwillingness to get a COVID-19 vaccine. Reasons cited by respondents included distrust of the government, wariness about the rapidity with which vaccines were being developed, and skepticism that they were at higher risk.
Respondents in the APF survey also said, however, that they trust their own doctor more than any other individual when it comes to making healthcare decisions, which is consistent with other surveys showing that people trust the most their healthcare providers for information on COVID-19 and vaccinations. It means that, as trusted messengers, health professionals are in the best position to help persuade patients of the safety of the vaccines and of the many important benefits of becoming vaccinated.
There is no evidence that COVID-19 vaccines are less safe or effective for people who use substances, people who have SUDs, or people who are receiving medications to treat addiction. And for these individuals, the benefits go well beyond reducing the risk of contracting or experiencing the worst effects from COVID-19. Importantly, vaccination enables safely gathering with others again. Isolation is a risk factor for relapse to drug use, and recovery groups have had to suspend in-person meetings this past year. For some, virtual meetings have been a lifeline; for others, they are not an adequate substitute for face-to-face interactions and may not even possible. Thus, for people with addiction and perhaps other mental health conditions like depression or anxiety that have been exacerbated by the stress of isolation, vaccination will bring a return to normalcy, including greater access to social supports.
People who use drugs also need not have privacy concerns when obtaining a vaccine for fear of having to disclose past or present drug use. Providers administering COVID-19 vaccine will not ask about your substance use. Recipients will not need to disclose information about medical history, other than known allergies to vaccines or immune- or blood-related conditions potentially relevant to receiving a vaccine. The pre-vaccination screening form issued by the CDC can be downloaded.
Healthcare providers, pharmacies, treatment centers, and others who are part of the vaccine-dispensing effort should prioritize trying to reach people in their community who use drugs. Opioid treatment programs and syringe-services programs, for example, should also make vaccines available at their facilities. Walk-in vaccination clinics are now available in some locations to serve people with complicated schedules and housing situations.
Some of the innovative strategies implemented during the pandemic to deliver addiction treatment and medications to people with substance use disorders, such as mobile vans dispensing medications for opioid use disorder, could be leveraged to provide COVID-19 vaccines as well. Telehealth modalities increasingly used for medication management can be used to inform and encourage patients to get vaccinated. Treatment centers and other providers can also contact their patients via text message. With funding from the Foundation for Opioid Response Efforts, APF has established a Vaccine Navigator to help people with drug problems navigate local vaccine scheduling complexities and to address any concerns they may have about getting vaccinated.
For more information about vaccines, how they were developed, and the importance of becoming vaccinated, see the APF video I recorded with Dr. Fauci.