COVID-19 and People at Increased Risk

Having a substance use disorder can make you more likely to get severely ill from COVID-19. People who use drugs may also have underlying medical conditions that put them at increased risk for severe illness from COVID-19, and they may have concerns and questions related to their risk. Additionally, recent data and reports show that fatal drug overdoses in the United States have been increasing before and during the COVID-19 pandemic.

This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available.

COVID-19 Risk and Severity

People who use drugs and live in congregate (group) settings or who gather with others are at increased risk of exposure to the virus that causes COVID-19. People with underlying medical conditions, such as substance use disorder, chronic lung disease, chronic liver disease, or serious heart conditions, are more likely to get severely ill from COVID-19. We know that drug use can have serious effects on the body. For example:

• The use of opioids can cause slow breathing, and can even result in ineffective breathing, which can lead to decreased oxygen in the blood, brain damage, or death.
• The use of stimulants, such as cocaine, amphetamine, and methamphetamine, can cause acute health problems such as stroke, heart attacks, abnormal heart rhythm, and seizures, as well as more chronic conditions, such as heart or lung damage.
• The use of drugs by smoking or vaping (for example, heroin, crack cocaine, marijuana) can make chronic obstructive pulmonary disease (COPD), asthma, and other lung conditions worse.
• Other conditions that affect the immune response, such as HIV, are more common among people who use drugs, especially among those who inject drugs.

People with a substance use disorder are at increased risk of severe illness and death from COVID-19.^1,2,3

Increased Substance Use During the COVID-19 Pandemic

Increased stress can lead to increases in alcohol and substance use. If you or someone you care about is using alcohol or other substances, or is increasing their use during the COVID-19 pandemic, here are a few suggestions that may help:

• Contact your healthcare provider
• Attend a virtual treatment or recovery program
• Discuss options for medications to treat alcohol or opioid use disorders with your healthcare provider.
• Take medicine as prescribed and continue therapy, treatment, or support appointments (in person or through telehealth services) when possible
• Call the National Drug and Alcohol Treatment Referral Routing Service (1-800-662-HELP) to speak with someone about your alcohol or substance use problem
• Practice harm reduction techniques to minimize risks to yourself or loved ones

Safer Drug Use During COVID-19

An overdose may be less likely to turn fatal if others are present when you use drugs. If you are with others, protect yourself and them.

• Get the COVID-19 vaccine when it is available to you
• Wear a mask. However, if a person is unconscious, incapacitated, or otherwise unable to remove a mask without help, they should not wear one.
• Stay at least 6 feet apart from others
• Avoid crowds and poorly ventilated indoor spaces
• Wash your hands often with soap and water for at least 20 seconds
• Avoid touching your face or your injection site with your bare hands. To prevent infection, always wash your hands and wash any injection sites with soap and water before and after handling drugs. If soap and water are not available, you can use alcohol wipes or a hand sanitizer with at least 60% alcohol.

Practice Harm Reduction Strategies

If you are unable to avoid using drugs alone, practice harm reduction strategies. Harm reduction strategies aim to reduce negative consequences associated with drug use. The following suggestions are important to help keep you safe anytime you use drugs and not just during the COVID-19 pandemic:

• Use small amounts of a drug at a time.
• Tell a friend or family member when and where you will be using and ask them to check in on you at specific times.
• Use an overdose prevention smartphone app to ensure help is called if you need it.

If you use opioids (including heroin), or other drugs such as cocaine that might be mixed with opioids like fentanyl, follow the harm reduction strategies listed above. You should provide naloxone to a friend or family member who will check on you, if possible, in case you experience an overdose. If you do not have naloxone, talk to your healthcare provider or contact your local pharmacy (most states allow pharmacists to dispense naloxone without a prescription) to get access to this life-saving medication. You can also get naloxone from community-based naloxone programs and most syringe services programs. This is especially important due to recent data and reports showing that fatal overdoses, especially overdoses involving fentanyl, are on the rise.

Other precautions

Precautions taken to avoid harm from drug use can also help you avoid COVID-19. These precautions will also reduce the risk of other infections and overdose. People using drugs can:

• Avoid sharing drug-use equipment (for example, items used for injecting, vaping, smoking, and snorting drugs). Clean equipment thoroughly if sharing can’t be avoided. Stock up on supplies if possible. For people who inject drugs, ask your local syringe services program if they have ways to reduce in-person visits.
• When possible, avoid using drugs prepared by other people. If other people prepare drugs for you, make sure they wash their hands properly before doing so.
• Minimize close contact with other people when getting and using drugs by keeping a distance of at least 6 feet as much as possible, wearing a mask, avoiding crowds and poorly-ventilated indoor spaces, and washing hands with soap and water for at least 20 seconds after contact. If soap and water are not available, you can use a hand sanitizer with at least 60% alcohol. Be aware that masks can be dangerous if a person is unconscious, incapacitated, or otherwise unable to remove the mask without help.
• Use services provided by syringe services programs, if available, which include clean syringes, safe disposal of used syringes, testing for HIV and hepatitis B and C, and a range of other services including linking to care and treatment for substance use disorder and infectious diseases.
• Mail order options from community organizations may help you access sterile supplies while reducing your chances of exposure to COVID-19.

Access to Treatment for Substance Use Disorder During COVID-19

All healthcare facilities are taking steps to protect their patients and staff from COVID-19. Do not delay getting help because you are afraid of getting COVID-19. You can take steps to protect yourself and others while you get the help you need. If you need emergency services right away (for example, if you or someone you know is experiencing a drug overdose), call 9-1-1 or go to the nearest emergency department or urgent care center. If you do not need emergency care but need medical attention or want to start treatment as soon as possible, call your local healthcare facility or your healthcare provider to discuss treatment options. Many providers are using telemedicine so that people can access services without an in-person visit.

The following resources can help you find a specialized provider:

• SAMHSA’s National Helpline: 1-800-662-HELP (4357) and TTY 1-800-487-4889
• SAMHSA’s Treatment Services Locator
• Consider virtual meetings

Disruptions in treatment during COVID-19

Disruption in your treatment can be very stressful. If you have a regular doctor, ask if they can offer treatment or refer you to another treatment program with “telehealth” options, such as online meetings or visits. You can also look for resources listed in the SAMHSA treatment locator or call SAMHSA’s National Helpline: 1-800-662-HELP. Virtual recovery resources are available if in-person visits are not. Many opioid treatment programs, substance use treatment centers, and syringe services programs remain open during emergencies like the COVID-19 pandemic because they are considered essential services. Certain medications for opioid use disorder can also be offered through telehealth during the COVID-19 pandemic. If you are currently enrolled in a program and are concerned that you may lose access to care, discuss this concern with your healthcare provider.

COVID-19 Vaccination

Substance use disorder is considered an underlying medical condition that increases the risk of serious, life-threatening complications from COVID-19. COVID-19 vaccinations are recommended for and can be administered to most people with underlying conditions.

Most people aged 16 years and older can receive a free COVID-19 vaccination regardless of current drug use or a history of drug use.

Many state and local vaccination programs are currently planning how to get vaccines to people who do not have a way to get to a vaccination location or do not have access to a regular healthcare provider. Refer to your state or local health department for the latest on whether vaccination at your syringe services program, federally qualified health center, or other location where you regularly receive services is planned. If you need assistance with scheduling your vaccine, you may be eligible to receive help from a vaccine ambassador program or another vaccination outreach program in your community.

Visit CDC’s Frequently Asked Questions about COVID-19 Vaccination web page for accurate and up-to-date information about COVID-19 vaccination. For more information about the COVID-19 vaccines, benefits of being vaccinated, and what to expect during your vaccination and afterwards, see:

• Key Things to Know About COVID-19 Vaccines
• Benefits of Getting a COVID-19 Vaccine
• What to Expect at Your Appointment to Get Vaccinated for COVID-19
• What to Expect after Getting a COVID-19 Vaccine
• Vaccines.gov

References

1. Wang QQ, Kaelber DC, Xu R, Volkow ND. COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Mol Psychiatry. 2020 Sep 14:1–10. doi: 10.1038/s41380-020-00880-7. Epub ahead of print. Erratum in: Mol Psychiatry. 2020 Sep 30;: PMID: 32929211; PMCID: PMC7488216.
2. Baillargeon J, Polychronopoulou E, Kuo YF, Raji MA. The Impact of Substance Use Disorder on COVID-19 Outcomes. Psychiatr Serv. 2020 Nov 3:appips202000534. doi: 10.1176/appi.ps.202000534. Epub ahead of print. PMID: 33138712.
3. Allen B, El Shahawy O, Rogers ES, Hochman S, Khan MR, Krawczyk N. Association of substance use disorders and drug overdose with adverse COVID-19 outcomes in New York City: January-October 2020. J Public Health (Oxf). 2020 Dec 26:fdaa241. doi: 10.1093/pubmed/fdaa241. Epub ahead of print. PMID: 33367823.