Recent research from Boston Medical Center found that substance use disorders don’t increase the likelihood of dying from COVID-19. Published in Substance Abuse: Research and Treatment, the study showed that the increased risk for severe COVID-19 in individuals with SUD that has been seen will be the results of co-occurring medical conditions.
Multiple large cohort studies from early within the pandemic have shown higher rates of hospitalization, intubation, and death from COVID-19 in those with SUD, while other studies found no association between SUD and COVID-19-related mortality or mixed results depending on substance use pattern. Given these conflicting data, the Centers for Disease Control and Prevention has classified individuals with SUD as suggestive of upper risk for severe COVID-19. The goal of this study was to evaluate the association between SUD and inpatient COVID-19-related mortality.
BMC is understood for excellent clinical care and revolutionary research related to substance use disorder. For the reason that early days of the pandemic, BMC has also been a pacesetter within the treatment of people with COVID-19, including individuals with complex medical and social needs. These findings showing the same likelihood of COVID-19-related complications in hospitalized patients with and without SUD helps expand knowledge of the infectious complications of SUD.”
Angela McLaughlin, MD, MPH, first writer, infectious disease fellow at Boston Medical Center
As BMC sees a high proportion of patients who use substances, it was an apt location for the study: almost 14% of the study population had SUD, exceeding the national average of 10.8% in people ages 18 or older. Researchers reviewed medical records of 353 adults without SUD and 56 adults with SUD admitted to Boston Medical Center early into COVID-19 pandemic and compared the likelihood of COVID-19 related complications between individuals with and without substance use disorders. They compared the connection between COVID-19 and mortality, clinical complications, and resource utilization.
“Early within the pandemic, BMC developed protocols to closely monitor and quickly manage COVID-19-related complications in all hospitalized patients,” said senior writer Sabrina Assoumou, MD, MPH, an infectious disease doctor at Boston Medical Center and Assistant Professor of Medicine at Boston University Chobanian & Avedisian School of Medicine. “The present findings suggest that such an approach might need benefited many patients, including individuals with substance use disorders.”
On this retrospective cohort study of patients admitted to a security net hospital in the course of the early phase of the COVID-19 pandemic, SUD was not related to the first final result of COVID-19-associated inpatient mortality. The secondary evaluation showed that those with and without SUD had similar COVID-19-related clinical complications, including secondary infections, renal failure requiring dialysis, acute liver injury, venous thromboembolism, cardiac complications, and the composite “any complications.” Of note, some clinical outcomes resembling stroke were very unusual overall. Likewise, there was no difference in resource utilization secondary outcomes between the 2 groups. In contrast to other studies, this found similar likelihoods of mechanical ventilation and ICU admission in patients with and without SUD. Although patients with SUD presented to the hospital earlier of their disease course, their total hospital length of stay was ultimately much like patients without SUD. Insights resembling these into the clinical complications and resource utilization patterns of patients with SUD and COVID-19 can assist clinicians anticipate the trajectory of infection and healthcare needs on this vulnerable group.
There have been some notable limitations to the study. The outcomes are from a single site, which could limit generalizability of the findings despite the racial and ethnic diversity of the BMC patient population. Second, the information presented are from the earliest phase of COVID-19 in america, so trends could have differed with subsequent waves and as COVID-19 management strategies have evolved over time. Third, there have been no specific controls for socioeconomic aspects like medical insurance status or income level, as over 75% of the BMC patient population has public payer insurance (Medicare, Medicaid, or Kid’s Health Insurance Program) or no insurance. Lastly, differences in COVID-19 outcomes between current versus past SUD couldn’t be detected – this area would profit from further research.
In conclusion, on this study of hospitalized individuals at an urban safety net hospital with a various patient population within the early days of the COVID-19 pandemic, inpatient mortality and morbidity between patients with and without SUD were similar. The findings provide an in depth evaluation of outcomes in a singular patient population that has been disproportionately impacted by COVID-19 and will provide helpful insights for similar settings across the country. These results point away from SUD as an independent risk factor for severe COVID-19 and further suggest a concentrate on medical comorbidities to mitigate the results of COVID-19. Additional studies are needed to further evaluate for differential outcomes on this high-risk population, particularly in an era of newer COVID-19-directed therapies.
Source:
Journal reference:
McLaughlin, A., et al. (2023). Comparing COVID-19-related Morbidity and Mortality Between Patients With and Without Substance Use Disorders: A Retrospective Cohort Study. Substance Abuse: Research and Treatment. doi.org/10.1177/11782218231160014.