Clinical Outcomes From COVID-19 Infections Poorer Among Patients With Substance Use Disorders

Similar Neurocognitive Deficits Present in ADHD, Substance Abuse, and Conduct Disorder
Similar Neurocognitive Deficits Present in ADHD, Substance Abuse, and Conduct Disorder
Study authors examined the impact of substance use disorder on the risk of hospitalization, complications, and mortality among adult patients diagnosed with COVID-19.

Patients who had substance use disorders had worse clinical outcomes from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. These results, from a double-cohort study, were published in Psychiatric Services in Advance.

Researchers from the University of Texas Medical Branch queried the TriNetX Research Network platform, which collects electronic medical records from 35 health care organizations across the United States. Data from adult patients (N=54,529) diagnosed with SARS-CoV-2 between February 20 and June 30 2020 and had visited the doctor within the previous 12 months were included. Patients were assessed for clinical outcomes.

A total of 10.2% of the patients had been diagnosed for a substance use disorder. Patients with and without substance use disorder differed significantly for rates of hypertension (55.5% vs 42.4%; P <.001), chronic obstructive pulmonary disease (19.5% vs 5.5%; P <.001), ischemic heart disease (24.9% vs 12.3%; P <.001), and cerebrovascular disease (15.3% vs 8.0%; P <.001), respectively.

To avoid potential bias from significant cohort differences, a subset of 5450 individuals were selected from each group for the final analysis.

Substance use disorder was associated with a significantly increased risk for hospitalization (30.9% vs 22.6%; odds ratio [OR], 1.53, 95% CI, 1.40-1.65) and with requiring mechanical ventilation (5.4% vs 4.3%; OR, 1.28; 95% CI, 1.07-1.52) after infection.

Among all patients, substance use disorder was associated with SARS-CoV-2-related mortality (4.9% vs 3.8%; OR, 1.30; 95% CI, 1.08-1.56), however within the propensity-matched subsample, substance use disorder was no longer associated with mortality (4.7% vs 4.7%; OR, 1.00; 95% CI, 0.84-1.20).

This study may not be an unbiased representation of the United States as all the data were sourced from centers that were in the care network of 35 health care organizations.

The study authors concluded individuals with substance use disorder were at increased risk for needing hospitalization and for being put on a ventilator after being diagnosed with SARS-CoV-2. Longitudinal studies are needed for relating various abused substances with the medications used to treat SARS-CoV-2 and with the pathways involved with the SARS-CoV-2 infection.

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Baillargeon J, Polychronopoulou E, Kuo Y-F, Raji MA. The Impact of Substance Use Disorder on COVID-19 Outcomes (published online November 3, 2020). Psychiatr Serv. doi: 10.1176/