COVID-19 Questions and Answers: For People Who Use Drugs or Have Substance Use Disorder

COVID-19 Questions and Answers: For People Who Use Drugs or Have Substance Use Disorder

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.

For People Who Use Drugs or Have Substance Use Disorder

Some people who use drugs might face more exposures or opportunities for infection through congregate (group) living settings or gathering with others. People with underlying medical conditions such as chronic lung disease, chronic liver disease, and serious heart conditions seem to be more likely to get severely ill from COVID-19. We know that drug use can have serious effects on the body, including:

  • 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 (e.g., 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.

Having a substance use disorder has been shown to increase the risk of severe illness and death from COVID-19.1,2,3

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 locatorexternal icon or call SAMHSA’s National Helpline, 1-800-662-HELPexternal icon. Virtual recovery resources are availableexternal icon if in-person visits are not. Many opioid treatment programsexternal icon, substance use treatment centers, and syringe services programsexternal icon 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 current healthcare provider.

Fear and anxiety about a disease can feel overwhelming for some people. 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. All healthcare facilities are taking steps to protect their patients and staff from COVID-19 and you should not delay getting help because you are afraid of getting COVID-19. You can also get immediate help by calling:

  • Disaster Distress Helplineexternal icon: call or text 1-800-985-5990
  • Veteran’s Crisis Line: 1-800-273-TALK (8255) or Crisis Chat or text: 8388255
  • National Suicide Prevention Lifeline: 1-800-273-8255

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:

If you use opioids (including heroin), or other drugs that might contain an opioid such as fentanyl (for example, cocaine), having naloxone available may save your life in the case of an opioid overdose. Talk to your healthcare provider or your local pharmacy (most states allow people to get naloxone without a prescription) to get a supply of naloxone. You can also get naloxone from community-based naloxone programsexternal icon and most syringe service programsexternal icon. Make sure your family and friends know where to find naloxone and how to use it. This is especially important due to recent data and reports showing that fatal overdoses, especially overdoses involving fentanyl, are on the rise.

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:

For immediate help in a crisis:

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. Wear a mask, stay 6 feet apart, avoid crowds and poorly-ventilated indoor spaces, wash your hands often with soap and water for at least 20 seconds, and avoid touching your face or your injection site with your bare hands. Washing hands and any injection sites with soap and water before and after handling drugs is always important to prevent infection. Use alcohol wipes or a sanitizer with at least 60% alcohol if soap and water are not available. Be aware that face masks can be dangerous if a person is unconscious, incapacitated, or otherwise unable to remove the mask without help.

If you are unable to avoid using drugs aloneexternal icon, practice harm reduction strategiesexternal icon. Harm reduction strategies are aimed at reducing negative consequences associated with drug use and the following suggestions are important to help keep you safe anytime you use drugs and not just during the COVID-19 pandemic. Some useful harm reduction strategies include:

  • 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 same harm reduction strategies listed above. You should also provide naloxone to a friend or family member who will check on you, if possible. 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 programsexternal icon and most syringe services programsexternal icon. This is especially important due to recent data and reports showing that fatal overdoses, especially overdoses involving fentanyl, are on the rise.

Precautions taken to avoid harm from drug use can also help you avoid COVID-19 infection. 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 thoroughlypdf icon 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 or ensure proper handwashing by people who have prepared drugs for you.
  • 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.

Because the supply of COVID-19 vaccine in the United States is currently limited, CDC is providing recommendations to federal, state, and local governments about who should be vaccinated first. CDC’s recommendations are based on those of the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts.

Each state has its own plan for deciding which groups of people will be vaccinated first. You can contact your state health department for more information on its plan for COVID-19 vaccination.

The goal is for everyone to be able to easily get a COVID-19 vaccination as soon as large quantities of vaccine are available. As the vaccine supply increases, more groups will be added to receive vaccination. Learn more about CDC recommendations for who should get vaccinated first.

Although most state vaccination plans do not specify whether substance use disorder would be prioritized in earlier phases, some people with substance use disorder might reside in congregate living settings. The Advisory Committee on Immunization Practices (ACIP) recognizes that increased rates of transmission have been observed in congregate living settings. While CDC makes recommendations for who should be offered COVID-19 vaccine first, each state has its own plan for deciding who will be vaccinated first and how they can receive vaccines.

COVID-19 vaccination state and local planning and distribution for populations is in progress. Refer to your state or local health department for the latest on whether vaccination at your SSPs is planned.

Visit CDC’s Frequently Asked Questions about COVID-19 Vaccination webpage 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

For Medical Professionals

Increased stress can lead to increases in alcohol and substance use. Here are a few suggestions that may help:

  • Screen all adult patients for excessive drinking.
  • Advise patients who screen positive for drinking too much to drink less (and refer people who might have an alcohol use disorder to specialized treatment).
  • Screen all adults for substance use and refer people who might have a substance use disorder to specialized treatmentexternal icon.
  • Ensure patients with opioid use disorder, as well as patients who use other drugs such as cocaine that might be mixed with opioids, such as fentanyl, have a prescription for naloxone.
  • Refer patients to peer recovery supportexternal icon
  • Refer patients who inject drugs to a syringe services programexternal icon.

Some people who use drugs might face more exposures or opportunities for infection through congregate living settings or gathering with others that could increase the likelihood of getting COVID-19. People with substance use disorder are also more likely to have other health conditions that might increase susceptibility to COVID-19 and to other infections, such as heart disease, lung disease, chronic liver disease, and type 2 diabetes.1 Recent studies have found that the occurrence of COVID-19 is higher for people who have substance use disorder than for those who don’t.1,4 Also, some underlying medical conditions such as chronic lung disease and serious heart conditions seem to increase risk of severe illness from COVID-19. If the patient’s drug use has affected their overall health, they may be at increased risk of severe illness from COVID-19.

We know that:

  • 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.

For these reasons, it is possible that drug use could make COVID-19 illness more severe. Having a substance use disorder has been shown to increase the risk of severe illness and death from COVID-19.1,2,3

Yes, all forms of naloxone can still be given safely during the COVID-19 pandemic. Always use the appropriate personal protective equipment when treating a patient with suspected or confirmed COVID-19.

Disruption in treatment for patients who use drugs or with substance use disorder can be very stressful. These disruptions can include loss of in-person treatment options for substance use disorder (for example, clinic appointments for getting medication for opioid use disorder and access to other support services), which can lead to increased use or return to drug use for people not currently using.

Consider offering virtual face-to-face interaction via technologies to provide more personalized support. Disruptions can also occur in patients who use syringe services programs, which may limit access to clean syringes, safe disposal of used syringes, testing for infectious diseases, access to naloxone, and referral to care for treatment of substance use disorder and infectious diseases.

Patients may also experience a disruption in access to their typical illicit drug supply which can lead to withdrawal and emotional distress. If they get contaminated drug products, they may be at increased risk of overdose or other adverse reactions.

If patients present with acute withdrawal, overdose, or other adverse reactions from drug use, take time to have a nonjudgmental conversation with them about their use, work with them to find alternative treatment strategies, and offer harm reduction strategies that align with their current needs. For example, your patient may not be ready to stop their drug use but may benefit from information about syringe service programs and prescription for naloxone.

If you have not done so already, healthcare providers with an active Drug Enforcement Agency (DEA) license are eligible to complete an approvedexternal icon training and submit an application to SAMHSA for outpatient prescribing of buprenorphine for the treatment of opioid use disorder.

More information and resources can be found at:

Yes, as part of the national public health emergency, under certain circumstances and for specifically qualified clinicians, telehealth options are available to treat patients who use drugs or who have a substance use disorder. Many health care facilities are using telehealth to expand access to essential health services during the COVID-19 pandemic. Exceptionspdf iconexternal icon for treatment of opioid use disorder during the COVID-19 pandemic allow office-based clinicians with a DATA 2000 waiverexternal icon to start buprenorphine treatment via telehealthpdf iconexternal icon without requiring an in-person physical exam. In addition to expanding prescribing options, new exceptions allow more flexibility for how opioid treatment programs provide take-home doses of methadone and buprenorphine.

In July 2020, the U.S. Food and Drug Administration announced new rulesexternal icon requiring that all labeling for opioid pain medications and medications for opioid use disorder be updated to recommend that health care providers routinely discuss the availability of naloxone with patients and caregivers. Clinicians should consider prescribing naloxone, and training patients and caregivers how to use it, when starting patients on opioid treatment (including medications for opioid use disorder) and at follow up appointments.

Because the supply of COVID-19 vaccine in the United States is currently limited, CDC is providing recommendations to federal, state, and local governments about who should be vaccinated first. CDC’s recommendations are based on those of the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts.

Each state has its own plan for deciding which groups of people will be vaccinated first. You can contact your state health department for more information on its plan for COVID-19 vaccination.

The goal is for everyone to be able to easily get a COVID-19 vaccination as soon as large quantities of vaccine are available. As the vaccine supply increases, more groups will be added to receive vaccination. Learn more about CDC recommendations for who should get vaccinated first.

Although most state vaccination plans do not specify whether substance use disorder would be prioritized in earlier phases, some people with substance use disorder might reside in congregate living settings. The Advisory Committee on Immunization Practices (ACIP) recognizes that increased rates of transmission have been observed in congregate living settings. While CDC makes recommendations for who should be offered COVID-19 vaccine first, each state has its own plan for deciding who will be vaccinated first and how they can receive vaccines.

Building good relationships with patients and communicating current and accurate information about the COVID-19 vaccine is essential. CDC has prepared several tools to assist health care providers and patients with obtaining and communicating trusted information about COVID-19 vaccination, including the CDC COVID-19 Vaccination Communication Toolkit, the Answering Your Questions About the New COVID-19 Vaccinespdf icon handout, and resources for talking to recipients about COVID-19 vaccines. Providers can also share information with their patients about how to access vaccines, such as checking VaccineFinderexternal icon or reaching out to the local health departmentexternal icon.

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.
  4. Ji W, Huh K, Kang M, Hong J, Bae GH, Lee R, Na Y, Choi H, Gong SY, Choi YH, Ko KP, Im JS, Jung J. Effect of Underlying Comorbidities on the Infection and Severity of COVID-19 in Korea: a Nationwide Case-Control Study. J Korean Med Sci. 2020 Jun 29;35(25):e237. doi: 10.3346/jkms.2020.35.e237. PMID: 32597048; PMCID: PMC7324262.