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Abstract
Background There is limited evidence quantifying the risk of severe COVID-19 disease among people with opioid dependence. We examined vaccine uptake and severe disease (admission to critical care or death with COVID-19) among individuals prescribed opioid agonist therapy (OAT).
Method A case–control design was used to examine vaccine uptake in those prescribed OAT compared with the general population, and the association between severe disease and OAT. In both analyses, 10 controls from the general population were matched (to each OAT recipient and COVID-19 case, respectively) according to socio-demographic factors. Conditional logistic regression was used to estimate rate ratios (RR) for severe disease.
Results Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53% and dose 3: 31%) compared with matched controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared with those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75 to 4.15), particularly in the fourth wave (RR 6.58, 95% CI 4.20 to 10.32); adjustment for comorbidity and vaccine status attenuated this risk (adjusted RR (aRR) 2.43, 95% CI 1.95 to 3.02; wave 4 aRR 3.78, 95% CI 2.30 to 6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11 to 2.71).
Conclusions The widening gap in vaccine coverage for those prescribed OAT, compared with the general population, is likely to have exacerbated the risk of severe COVID-19 in this population over the pandemic. However, continued OAT use may have provided protection from severe COVID-19 among those with opioid dependence.
- COVID-19
- substance abuse
- record linkage
Data availability statement
Data may be obtained from a third party and are not publicly available. Access to the individual level data can be sought through approval of the Public Benefit and Privacy Panel for Health and Social Care (www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/).
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Data availability statement
Data may be obtained from a third party and are not publicly available. Access to the individual level data can be sought through approval of the Public Benefit and Privacy Panel for Health and Social Care (www.informationgovernance.scot.nhs.uk/pbpphsc/home/for-applicants/).
Footnotes
Contributors AY was responsible for the overall content as guarantor. SH conceived and designed the study. AY did the statistical analyses and wrote the first draft of the manuscript. JB, BT, LB and JL contributed to data curation. MW, BT, NP, CC, DM, TC, AM and SH reviewed and edited the manuscript. All authors have read and approved the final version of the manuscript.
Funding This research was supported by funding from Public Health Scotland.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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