Adults with Substance Use Disorder are More Likely to Become Sick with COVID-19

COVID-19 causes increased adverse effects among those with at least one pre-existing, underlying health condition. Commonly known pre-existing conditions include lung disease, obesity, liver disease, and heart conditions. While individuals with Substance Use Disorder (SUD) are also at an increased risk of becoming severely ill from COVID-19, the increased stigma around this group has unfortunately meant that their risk has not been widely acknowledged or discussed.

This lack of understanding may pose severe consequences, as people with an SUD are more likely to become hospitalized or die from COVID-19.

Substance Use during COVID

The COVID-19 pandemic has seen mental health issues and substance use increase exponentially.

Various experts warned that related stressors such as lockdowns, social distancing, and economic difficulties would cause heightened mental health issues throughout the coronavirus pandemic.  The World Health Organization (WHO) stated that substance use was soaring due to these stressors as well as emotional turmoil such as isolation and grief.[1]

2020 saw overdose deaths in America rise to an all-time high by nearly 30%, with around 93,000 fatalities.[2]  The Centers for Disease Control and Prevention also stated that the increase in deaths was driven by the lethal prevalence of synthetic opioids and difficulty accessing care and treatment services.

60% of countries worldwide experienced service interruptions due to the pandemic, and WHO reported that the services most commonly interrupted—including therapy, counseling, harm reduction services, syringe programs, and treatment for opioid abuse–were those most needed by vulnerable demographics. [3].[4]

Health Risks

Substance use has serious physiological consequences, many of which increase the risks of developing a severe case of COVID-19. These include:[5]

  • The use of opioids slows breathing and frequently results in ineffective breathing.  This decreases oxygen levels in the blood, which can cause brain damage and even death in severe instances.
  • The use of stimulants, such as amphetamine, cocaine, and methamphetamine, can cause serious health complications, including abnormal heart rhythm, stroke, heart attacks, and seizures. Stimulants can also cause chronic illnesses, such as lung or heart damage.
  • Smoking or vaping drugs such as marijuana, heroin, and crack cocaine can result in chronic obstructive pulmonary disease (COPD), asthma, and other lung conditions.
  • Immune diseases, such as HIV, are more common among substance users, making the body more susceptible to infection.

Underlying chronic medical conditions are common in this demographic, and many will be at significant risk for developing a serious respiratory illness if they become infected with COVID-19.  There is an especially significant threat to those who smoke or vape substances due to how the virus targets the lungs.

Situational Vulnerability

Recreational substance use often occurs in a communal space occupied by a number of individuals, which increases the risk of exposure to the virus. Furthermore, substances or substance equipment are frequently shared, which heightens transmission risk. [6]

Precautionary advice frequently focuses on risks associated with the injection of substances. However, the COVID-19 pandemic has highlighted additional, less recognized risks from sharing marijuana joints, vaping, cigarettes, or inhalation devices.

Unfortunately, people with a Substance Use Disorder are more likely to experience incarceration or homelessness than the general population, which poses unique vulnerabilities. Incidences of substance use and infectious disease are high in prisons because they are closed, often windowless environments where over-crowding, inadequate infrastructure, and delayed infection diagnosis have been evidenced.[7] Homeless shelters pose similar risks.

Precautionary Measures

The following precautions will help prevent the spread of COVID-19 that results from substance use:  

  • To reduce transmission, the sharing of substances or substance equipment must be strongly discouraged. 
  • Social distancing and hygiene measures should be promoted.
  • Communication must appropriately target different groups of substance users, including marginalized groups such as the homeless and recreational substance users.
  • Clear messages are needed to promote the reduction of transmission and infection among substance users and substance service staff.
  • Substance users must be supported and encouraged to reduce their consumption of substances as a protective measure.
  • Further professional support and treatment centers are needed to help those who are seeking access to services.

COVID-19 and substance use are two pandemics on the verge of causing a major, combined public health threat. It is critical that we accelerate public awareness of the injurious effects that substance use has on a prognosis of COVID-19. Treatment centers and substance use services are essential in this time of need, and these must operate at optimum levels with appropriate funding and support. It is a shared responsibility to educate and protect one another, which will enable us all to live joyful, healthy lives free from substance use and its associated risks.

If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates.  Call 800-335-0316 or email


[1] Porterfield, Carlie. “Drug Overdose Deaths Surged 29% Last Year Amid Covid Pandemic, CDC Says”. Forbes, 2021,

[2] “A Record Number of Americans Died from Drug Overdoses in 2020”. The Economist, 2021,

[3] COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey”. Who.Int, 2021,

[4] COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey”. Who.Int, 2021,

[5] “COVID-19 and People at Increased Risk | Drug Overdose | CDC Injury Center”. Cdc.Gov, 2021,

[6] “COVID-19: Potential Implications for Individuals with Substance Use Disorders | National Institute On Drug Abuse”. National Institute On Drug Abuse, 2021,

[7] “The Implications of COVID-19 for People who use Drugs (PWUD) and Drug Service Providers | Www.Emcdda.Europa.Eu”. Emcdda.Europa.Eu, 2021,

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