Collision of the COVID-19 and Addiction Epidemics.
TL;DR: The risks of the collision of the COVID-19 and addiction epidemics are described, which could put at risk those who have opioid use disorder and methamphetamine use disorder.
Abstract: People with substance use disorder may be especially susceptible to COVID-19, and compromised lung function from COVID-19 could also put at risk those who have opioid use disorder and methamphetamine use disorder. This commentary describes the risks of the collision of the COVID-19 and addiction epidemics.
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TL;DR: The current evidence suggests that a psychiatric epidemic is cooccurring with the COVID-19 pandemic, which necessitates the attention of the global health community and multipronged interventions should be developed and adopted to address the existing psychosocial challenges and promote mental health amid the COIDs.
Abstract: The novel coronavirus disease 2019 (COVID-19) has become a pandemic affecting health and wellbeing globally. In addition to the physical health, economic, and social implications, the psychological impacts of this pandemic are increasingly being reported in the scientific literature. This narrative review reflected on scholarly articles on the epidemiology of mental health problems in COVID-19. The current literature suggests that people affected by COVID-19 may have a high burden of mental health problems, including depression, anxiety disorders, stress, panic attack, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, posttraumatic stress symptoms, and suicidal behavior. Moreover, several factors associated with mental health problems in COVID-19 are found, which include age, gender, marital status, education, occupation, income, place of living, close contact with people with COVID-19, comorbid physical and mental health problems, exposure to COVID-19 related news and social media, coping styles, stigma, psychosocial support, health communication, confidence in health services, personal protective measures, risk of contracting COVID-19, and perceived likelihood of survival. Furthermore, the epidemiological distribution of mental health problems and associated factors were heterogeneous among the general public, COVID-19 patients, and healthcare providers. The current evidence suggests that a psychiatric epidemic is cooccurring with the COVID-19 pandemic, which necessitates the attention of the global health community. Future epidemiological studies should emphasize on psychopathological variations and temporality of mental health problems in different populations. Nonetheless, multipronged interventions should be developed and adopted to address the existing psychosocial challenges and promote mental health amid the COVID-19 pandemic.
556 citations
TL;DR: Individuals with Sud, especially individuals with OUD and African Americans, are identified as having increased risk for COVID-19 and its adverse outcomes, highlighting the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support.
Abstract: The global pandemic of COVID-19 is colliding with the epidemic of opioid use disorders (OUD) and other substance use disorders (SUD) in the United States (US). Currently, there is limited data on risks, disparity, and outcomes for COVID-19 in individuals suffering from SUD. This is a retrospective case-control study of electronic health records (EHRs) data of 73,099,850 unique patients, of whom 12,030 had a diagnosis of COVID-19. Patients with a recent diagnosis of SUD (within past year) were at significantly increased risk for COVID-19 (adjusted odds ratio or AOR = 8.699 [8.411-8.997], P < 10-30), an effect that was strongest for individuals with OUD (AOR = 10.244 [9.107-11.524], P < 10-30), followed by individuals with tobacco use disorder (TUD) (AOR = 8.222 ([7.925-8.530], P < 10-30). Compared to patients without SUD, patients with SUD had significantly higher prevalence of chronic kidney, liver, lung diseases, cardiovascular diseases, type 2 diabetes, obesity and cancer. Among patients with recent diagnosis of SUD, African Americans had significantly higher risk of COVID-19 than Caucasians (AOR = 2.173 [2.01-2.349], P < 10-30), with strongest effect for OUD (AOR = 4.162 [3.13-5.533], P < 10-25). COVID-19 patients with SUD had significantly worse outcomes (death: 9.6%, hospitalization: 41.0%) than general COVID-19 patients (death: 6.6%, hospitalization: 30.1%) and African Americans with COVID-19 and SUD had worse outcomes (death: 13.0%, hospitalization: 50.7%) than Caucasians (death: 8.6%, hospitalization: 35.2%). These findings identify individuals with SUD, especially individuals with OUD and African Americans, as having increased risk for COVID-19 and its adverse outcomes, highlighting the need to screen and treat individuals with SUD as part of the strategy to control the pandemic while ensuring no disparities in access to healthcare support.
429 citations
Cites background from "Collision of the COVID-19 and Addic..."
...(diabetes, hypertension) [6–10] all of which are risk factors for COVID-19 infection and for worse outcomes [11–13] one can also predict that individuals with SUD including OUD would be at increased risk for adverse COVID-19 outcomes [2]....
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...alcohol on the susceptibility to COVID-19 infection and to adverse outcomes [2]....
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University of Colorado Boulder1, University of North Carolina at Chapel Hill2, University of Notre Dame3, University of South Florida4, Columbia University5, University of California, Irvine6, Rutgers University7, Stony Brook University8, University of Pittsburgh9, Yale University10, University of Oregon11, University of California, Berkeley12, Boston University13, Vanderbilt University14, University of Miami15, University of Minnesota16, Fordham University17, Harvard University18, Cornell University19, University of Michigan20, University of Central Florida21, University of California, Los Angeles22, University of Virginia23, Brown University24
TL;DR: COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training.
Abstract: COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
359 citations
TL;DR: The intricate bi-directional relationship between COVID-19 and addiction is analyzed, showing surge of addictive behaviors (both new and relapse) including behavioral addiction in this period and people with SUD are at greater risk of worse CO VID-19 outcome.
Abstract: Background and aims 2019-coronavirus disease (COVID-19) is causing insurmountable psychosocial impact on the whole mankind. Marginalized community, particularly those with substance use disorders (SUD), are particularly vulnerable to contract the infection and also likely to suffer from greater psychosocial burden. This article analyses the intricate bi-directional relationship between COVID-19 and addiction. Methods Pubmed and Google Scholar are searched with the following key terms- “COVID-19”, “SARS-CoV2”, “Pandemic”, “Addiction”, “Opioid”, “Alcohol”, “Smoking”, “Addiction Psychiatry”, “Deaddiction”, “Substance use disorders”, “Behavioral addiction”. Few newspaper reports related to COVID-19 and addiction have also been added as per context. Results People with SUD are at greater risk of worse COVID-19 outcome. There is surge of addictive behaviors (both new and relapse) including behavioral addiction in this period. Withdrawal emergencies and death are also being increasingly reported. Addicted people are especially facing difficulties in accessing the healthcare services which are making them prone to procure drugs by illegal means. Conclusion COVID-19 and addiction are the two pandemics which are on the verge of collision causing major public health threat. While every effort must be taken to make the public aware of deleterious effects of SUD on COVID-19 prognosis, the resumption of deaddiction services and easier accessibility of prescription drugs are needs of the hour.
271 citations
Cites background from "Collision of the COVID-19 and Addic..."
...There already exists a high prevalence of SUD among the homeless populace, migrant workers, prisoners and other marginalized communities and they are at increased risk of contracting the virus and facilitating transmission amongst others [2,32,74]....
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...Experts have advised to be vigilant regarding the possibility of increased risk for worse COVID-19 outcomes amongmethamphetamine abusers [32]....
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...Many of those addicts who are currently undergoing rehabilitation programs are not getting uninterrupted supply of medicines, appointment for their treating therapists, swift therapies for withdrawal manifestations and social support due to complete lock-down of transport, premature discharge from hospitals, altered triage system in hospitals [32,79]....
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...Nevertheless, social distancing, which is of paramount importance to keep the community transmission at bay, is indubitably playing as a detrimental factor in relapse of SUD during these days [32]....
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TL;DR: Health care professionals dealing with SUD must be aware of the risks and challenges they will meet during and after the COVID-19 outbreak, and addiction care must be reinforced, instead of postponed, in order to avoid complications of both SUD and COIDs and to prevent the transmission of coronavirus.
Abstract: The COVID-19 pandemic has brought major challenges to healthcare systems and public health policies globally, as it requires novel treatment and prevention strategies to adapt for the impact of the pandemic. Individuals with substance user disorders (SUD) are at risk population for contamination due to multiple factors-attributable to their clinical, psychological and psychosocial conditions. Moreover, social and economic changes caused by the pandemic, along with the traditional difficulties regarding treatment access and adherence-will certainly worsen during this period, therefore aggravate their condition. In addition, this population are potential vectors of transmission. In that sense, specific strategies for prevention and treatment must be discussed. health care professionals dealing with SUD must be aware of the risks and challenges they will meet during and after the COVID-19 outbreak. Addiction care must be reinforced, instead of postponed, in order to avoid complications of both SUD and COVID-19 and to prevent the transmission of coronavirus.
202 citations
Cites background from "Collision of the COVID-19 and Addic..."
...On the other hand, professionals dealing with COVID-19 may need special training to deal with substance users, assuming that treatment demand among these patients may increase (Volkow, 2020)....
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...These are conditions highly prevalent among substance users, and may require specific strategies that encompass the individual’s needs for prevention of COVID-19, SUD treatment and the protection of healthcare workers (Volkow, 2020)....
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References
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TL;DR: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d
Abstract: Background: Hospitalised COVID-19 patients are frequently elderly subjects with co-morbidities receiving polypharmacy, all of which are known risk factors for d
14,343 citations
TL;DR: It is shown that compared with smoke exposure, mice receiving ENDS vapor for 4 months failed to develop pulmonary inflammation or emphysema, and ENDS exposure, independent of nicotine, altered lung lipid homeostasis in alveolar macrophages and epithelial cells.
Abstract: Electronic nicotine delivery systems (ENDS) or e-cigarettes have emerged as a popular recreational tool among adolescents and adults. Although the use of ENDS is often promoted as a safer alternative to conventional cigarettes, few comprehensive studies have assessed the long-term effects of vaporized nicotine and its associated solvents, propylene glycol (PG) and vegetable glycerin (VG). Here, we show that compared with smoke exposure, mice receiving ENDS vapor for 4 months failed to develop pulmonary inflammation or emphysema. However, ENDS exposure, independent of nicotine, altered lung lipid homeostasis in alveolar macrophages and epithelial cells. Comprehensive lipidomic and structural analyses of the lungs revealed aberrant phospholipids in alveolar macrophages and increased surfactant-associated phospholipids in the airway. In addition to ENDS-induced lipid deposition, chronic ENDS vapor exposure downregulated innate immunity against viral pathogens in resident macrophages. Moreover, independent of nicotine, ENDS-exposed mice infected with influenza demonstrated enhanced lung inflammation and tissue damage. Together, our findings reveal that chronic e-cigarette vapor aberrantly alters the physiology of lung epithelial cells and resident immune cells and promotes poor response to infectious challenge. Notably, alterations in lipid homeostasis and immune impairment are independent of nicotine, thereby warranting more extensive investigations of the vehicle solvents used in e-cigarettes.
248 citations
"Collision of the COVID-19 and Addic..." refers background in this paper
...Preclinical studies show that e-cigarette aerosols can damage lung tissue, cause inflammation, and diminish the lungs' ability to respond to infection (3)....
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TL;DR: A population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010, found psychotropic drug use is associated with opioid-related death in patients receiving methadone, and mindfulness of these factors may reduce the risk of death among Methadone recipients.
65 citations
"Collision of the COVID-19 and Addic..." refers background in this paper
...Chronic respiratory disease increases risk for fatal overdose in those who use opioids therapeutically (4)....
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TL;DR: Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH.
Abstract: Objectives This study sought to characterize patients with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), to compare with MA controls (MA-CTL), users with structurally normal hearts, with the aim of identifying risk factors for these conditions. Background MA-PAH and MA-CMP are 2 poorly understood cardiac complications in MA users. Methods We retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients, whom we evaluated between 2010 and 2017. Results After a median follow-up of 20.0 months (interquartile range [IQR]: 7.6 to 42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for MA-CTL group (p Conclusions Both MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH. This study adds to the understanding of MA-associated cardiac complications and highlights directions for future investigation.
52 citations
"Collision of the COVID-19 and Addic..." refers background in this paper
...Methamphetamine is a highly toxic drug that causes pulmonary damage, pulmonary hypertension, and cardiomyopathy (6), and its use has markedly increased in the United States; clinicians should be alert to the possibility of increased risk for adverse COVID-19 outcomes in methamphetamine users....
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