Coronavirus disease 2019 (COVID-19) is a new illness that—according to currently available information and clinical expertise—impacts older adults and people who have serious underlying medical conditions with increased severity and higher prevalence.
The Centers for Disease Control and Prevention (CDC) lists a number of cohorts “at high-risk for severe illness” from COVID-19:
- People 65 years and older
- People who live in a nursing home or long-term care facility
- People of all ages with underlying medical conditions, including:
- People with chronic lung disease or moderate to severe asthma
- People who have serious heart conditions
- People who are immunocompromised
- Many conditions can cause a person to be immunocompromised, including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, and prolonged use of corticosteroids and other immune weakening medications
- People with severe obesity
- People with diabetes
- People with chronic kidney disease undergoing dialysis
- People with liver disease
Conspicuously absent from the CDC list is a group of people either not considered at high-risk or else as suffering from a “medical” condition: patients with substance use disorder (SUD). Many—although not all—of the “people with liver disease” will have alcohol use disorder.
The omission of SUD is a surprising oversight, considering America is still facing an addiction epidemic and that the director of the National Institute on Drug Abuse at the National Institutes of Health, Nora Volkow, M.D., warned last month on her blog that “the research community should be alert to the possibility that [COVID-19] could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.”
Dr. Volkow is certainly not the only concerned medical professional. Peter Grinspoon, M.D., is the author of the memoir Free Refills: A Doctor Confronts His Addiction. He is a primary care doctor who has recovered from—and who now treats —people with opioid use disorder. In April he wrote on the Havard Health Blog that
“People who suffer from the disease of addiction are particularly vulnerable to both catching the coronavirus and having a more severe disease when they do catch it. There are many reasons for this, but they boil down to something called social determinants of health, which according to the CDC are ‘conditions in the places where people live, learn, work, and play [which] affect a wide range of health risks and outcomes.’ In short, people suffering from addiction are vastly more vulnerable to coronavirus, as they are more likely to be homeless, poor, smokers with lung or cardiovascular disease, under- or uninsured, or have experienced serious health and socioeconomic issues from drug addiction.”
Due to their disease, people in active addiction are currently facing tremendous risks. Their substance misuse is potentially life-threatening by itself but they also engage in drug-seeking behavior that does not necessarily prioritize washing their hands, social distancing, or self-isolation. They are facing the double threat of their active addiction and possible COVID-19 infection. Because of their compulsive behavioral pattern, they are also more likely to spread the virus.
People in recovery from addiction, on the other hand, are an elevated risk of relapse. They face stressful social isolation and constraints on their support network. For example, people using 12-Step facilitation can no longer meet their sponsors in person and have to rely on virtual meetings.
Receiving professional addiction treatment is more complicated, too, at the moment. Like many other people with medical conditions, addicted individuals have been hesitant to seek treatment in a clinical environment. There are many reports of people delaying going to the hospital, even in cases of heart attack and stroke. The same reluctance seems to apply to people with a severe SUD.
The Farley Center’s medical director Jonathan Lee, M.D, recently told a webinar audience that his team has had to deal with “more stressors, more anxiety, and exacerbated drug and alcohol addictions” because of the pandemic.
The Farley team will continue to help people with substance use disorder to the best of their ability under these unprecedented circumstances. People in active addiction ready to go into recovery should not delay seeking treatment for their disease.
If you or someone you know is struggling with substance misuse but you are unsure what addiction treatment services are available at the moment, please contact The Farley Center at 757.280.1283 to find out about your options.