COVID-19 and Opioid Addiction: Risks and Potential Implications
The COVID-19 pandemic is the biggest public health crisis humankind has faced in more than a century. Nations around the world are in a race against time to slow the spread of the SARS-CoV-2 virus or coronavirus as it is commonly called. Governments are testing, treating, contact tracing, and quarantining affected individuals. Everyone is being encouraged to practice social distancing. Even as we contend with the virus, health experts are warning that COVID-19 could hit people with substance use disorders particularly hard. Because it attacks the lungs, the coronavirus could be an especially serious threat to people with opioid addiction.
Opioid Misuse and Addiction
Opioids are powerful drugs made from the opium plant or man-made in laboratories. They include prescription painkillers like hydrocodone, oxycodone, tramadol, and fentanyl. The street drug heroin is also an opioid. Opioid medications are highly addictive and must be used exactly as prescribed by a doctor. Unfortunately, some people misuse prescription opioids and become addicted to pain pills. It is not uncommon for a person to start with the misuse of prescription pain relievers and progress to heroin abuse.
Opioid addiction and overdose are serious public health problems in America. According to the National Institute on Drug Abuse, 128 people die from an opioid overdose every day in the United States. This includes prescription opioids, heroin, and illicit fentanyl, a powerful synthetic opioid.
COVID-19: An Emerging Health Threat
SARS-CoV-2, the virus that causes COVID-19, belongs to a family of viruses called coronaviruses. They are named so because corona means crown. This refers to the way the virus looks under the microscope. A coronavirus has pointed structures surrounding it that look like a crown. Many different coronaviruses have been identified over the years. Some coronaviruses cause mild respiratory illnesses like colds. Others are more serious and cause diseases like SARS and MERS.
COVID-19 is a serious respiratory illness caused by a new coronavirus that emerged in China in December 2019. The new coronavirus was named SARS-CoV-2. It spreads from person to person through tiny droplets that are expelled from the nose or mouth when an infected person exhales, sneezes, or coughs. Symptoms of COVID-19 include cough, fever, shortness of breath, muscle aches, and loss of taste or smell. COVID-19 can be a severe illness and may cause death in vulnerable individuals.
COVID-19 High-Risk Individuals
Some people are at a higher risk of contracting SARS-CoV-2. If infected, these individuals may suffer more severe consequences than others. Among the vulnerable groups are people who are older and have underlying health issues, such as respiratory conditions, cancer, heart disease, and diabetes. People with a smoking or vaping history have compromised lung function and are at risk of serious complications from COVID-19. A lesser-known vulnerable group consists of individuals who use opioids at high doses, either medically prescribed or those with an opioid use disorder.
Opioid Addiction and Coronavirus: Risks and Implications
Opioid medications are prescribed to treat chronic pain. However, the long-term use of opioids is controversial because of the potential for addiction and abuse. Roughly 20 to 30 percent of people who are prescribed opioids for chronic pain misuse them. Up to 12 percent develop an addiction and some transition to heroin abuse. Approximately 80 percent of heroin abusers report that they first misused prescription opioids. People with opioid use disorders are at increased risk from COVID-19 for several reasons.
Respiratory depression: Opioids act on the brain to slow breathing. The use of opioids not only puts the user at risk of a fatal overdose but can also lead to a dangerous decrease in blood oxygen levels (hypoxemia). People with COVID-19 who are using opioids may be more susceptible to respiratory depression.
Higher mortality: Mortality from opioid overdose is higher in people with chronic respiratory diseases. COVID-19 is associated with diminished lung capacity and could similarly endanger opioid abusers.
Reduced immunity: Another possible concern is that opioids suppress the immune system. People with opioid addiction are, therefore, at higher risk of acquiring infections like the SARS-CoV-2 virus.
Increased absorption: People receiving opioid medications by prescription are also at increased risk from coronavirus. Some opioids like buprenorphine and fentanyl are administered via the transdermal route (skin patches). One of the symptoms of a viral illness like COVID-19 is fever. Elevated body temperature can lead to increased absorption of the drug through the skin patch, increasing the risk of an overdose.
Substance Use Disorders and COVID-19
Data on the risks for COVID-19 in people with substance use disorders is still emerging. Even in the absence of a pandemic, people struggling with addiction face many challenges, including limited access to healthcare, housing insecurity, and risk of incarceration. Incarceration and homelessness expose people to environments where social distancing is all but impossible. Quarantine can disrupt access to medications, syringe exchange programs, and other support services necessary for people with addictions. If hospitals are pushed to capacity during the COVID-19 pandemic, people with substance use disorders will experience even greater barriers to accessing healthcare.
Multiple social, physiological, and environmental reasons put drug addicts at increased risk of coronavirus and its serious complications. We can only hope that healthcare systems struggling with the added burden of COVID-19 will not discriminate against people with addictions.