Health Services and Mortality Among Opioid Use Disorder Patients Diagnosed with COVID-19

Abstract

Background: The intersection between the opioid crisis and COVID-19 pandemic presents unprecedented challenges. Both opioid use and the novel SARS-CoV-2 affect respiratory and pulmonary health, which when co-occurring could put individuals with opioid use disorders (OUD) at higher risk to complications from COVID-19. We examine the relationship between OUD status and hospitalization, length of stay, risk for invasive ventilator dependence (IVD), and mortality from COVID-19. \n \nMethods: Multilevel linear models were employed using electronic health records data from the Cerner COVID-19 De-Identified Data Cohort from January through June 2020. \n \nFindings: Out of 52,312 patients with COVID-19, 1.9% (n=1,013) had an indication of OUD. Compared to non-OUD individuals, those with OUD indication had greater chance of hospitalization (86.9% vs. 52.3%, P<0.001), were hospitalized for longer periods (7.1 days vs. 6.0 days, P<0.001), had greater chance of IVD (18.6% vs. 11.6%, P<0.001), and had greater mortality (12.8% vs. 8.9%, P<0.001). After adjusting for confounding factors, COVID-19 patients with OUD had significantly higher odds of hospitalization (aOR=3.44, CI 2.81, 4.21), greater maximum length of stay ( =1.16, 95% CI 1.09, 1.22), and greater odds of IVD (aOR=1.26, CI 1.06, 1.49). When stratifying to patients younger than 45 years old, those with an OUD had significantly higher odds of dying (aOR=2.65, 95% CI 1.29, 5.47) compared to those without. \n \nInterpretation: This study highlights how the intersection between opioids and COVID-19 infection makes people with OUD more vulnerable to death and often in need to higher levels of care than other patients when contracting COVID-19. \n \nFunding: None; The authors acknowledge Cerner and Amazon Web Services for awarding Dr. Qeadan free data access and computation capabilities. We acknowledge NIH for partly supporting Drs. Qeadan, Madden, and English [grant number 5R61DA049382-02]. \n \nDeclaration of Interests: We declare no competing interests. \n \nEthics Approval Statement: The University of Utah Institutional Review Board (IRB #136696) has determined that this study does not meet the definitions of Human Subjects Research for using secondary data with no intervention or interaction with an individual, and for having identifiable private information in the data.