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. 2022 May 1:234:109383.
doi: 10.1016/j.drugalcdep.2022.109383. Epub 2022 Mar 3.

Substance use disorders and COVID-19: An analysis of nation-wide Veterans Health Administration electronic health records

Deborah S Hasin  1 , David S Fink  2 , Mark Olfson  3 , Andrew J Saxon  4 , Carol Malte  5 , Katherine M Keyes  6 , Jaimie L Gradus  7 , Magdalena Cerdá  8 , Charles C Maynard  4 , Salomeh Keyhani  9 , Silvia S Martins  6 , Ofir Livne  6 , Zachary L Mannes  6 , Scott E Sherman  10 , Melanie M Wall  3
Affiliations

Substance use disorders and COVID-19: An analysis of nation-wide Veterans Health Administration electronic health records

Deborah S Hasin et al. Drug Alcohol Depend. .

Abstract

Background: Substance use disorders (SUD) elevate the risk for COVID-19 hospitalization, but studies are inconsistent on the relationship of SUD to COVID-19 mortality.

Methods: Veterans Health Administration (VHA) patients treated in 2019 and evaluated in 2020 for COVID-19 (n=5,556,315), of whom 62,303 (1.1%) tested positive for COVID-19 (COVID-19+). Outcomes were COVID-19+ by 11/01/20, hospitalization, ICU admission, or death within 60 days of a positive test. Main predictors were any ICD-10-CM SUDs, with substance-specific SUDs (cannabis, cocaine, opioid, stimulant, sedative) explored individually. Logistic regression produced unadjusted and covariate-adjusted odds ratios (OR; aOR).

Results: Among COVID-19+ patients, 19.25% were hospitalized, 7.71% admitted to ICU, and 5.84% died. In unadjusted models, any SUD and all substance-specific SUDs except cannabis use disorder were associated with COVID-19+(ORs=1.06-1.85); adjusted models produced similar results. Any SUD and all substance-specific SUDs were associated with hospitalization (aORs: 1.24-1.91). Any SUD, cocaine and opioid disorder were associated with ICU admission in unadjusted but not adjusted models. Any SUD, cannabis, cocaine, and stimulant disorders were inversely associated with mortality in unadjusted models (OR=0.27-0.46). After adjustment, associations with mortality were no longer significant. In ad hoc analyses, adjusted odds of mortality were lower among the 49.9% of COVID-19+ patients with SUD who had SUD treatment in 2019, but not among those without such treatment.

Conclusions: In VHA patients, SUDs are associated with COVID-19 hospitalization but not COVID-19 mortality. SUD treatment may provide closer monitoring of care, ensuring that these patients received needed medical attention, enabling them to ultimately survive serious illness.

Keywords: COVID-19; Hospitalization; Mortality; Substance use disorder; Veterans Health Administration.

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Conflict of interest statement

Dr. Hasin reports funding from Syneos Health for unrelated projects on the validation and use of a measure of opioid addiction among patients with chronic pain. Andrew J. Saxon reports the following disclosures that are outside the submitted work: advisory board for Indivior, Inc., advisory board for Alkermes, Inc., travel support for Alkermes, Inc., and royalties for UpToDate, Inc. All other authors report no conflicts of interest.

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