Smoking marijuana could lead to breakthrough COVID cases, study finds:
The study, published last Tuesday in World Psychology, found that those with a substance use disorder (SUD) — a dependence on marijuana, alcohol, cocaine, opioids and tobacco — were more likely to contract the coronavirus after receiving both of their vaccination shots.
Individuals with substance use disorders (SUDs) are at increased risk for COVID-19 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID-19, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS-CoV-2 variants. In a population-based cohort study, we assessed the risk, time trends, outcomes and disparities of COVID-19 breakthrough infection in fully vaccinated SUD patients starting 14 days after completion of vaccination. The study included 579,372 individuals (30,183 with a diagnosis of SUD and 549,189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021, and had not contracted COVID-19 infection prior to vaccination. We used the TriNetX Analytics network platform to access de-identified electronic health records from 63 health care organizations in the US. Among SUD patients, the risk for breakthrough infection ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in non-SUD population (p<0.001). Breakthrough infection risk remained significantly higher after controlling for demographics (age, gender, ethnicity) and vaccine types for all SUD subtypes, except for tobacco use disorder, and was highest for cocaine and cannabis use disorders (hazard ratio, HR=2.06, 95% CI: 1.30-3.25 for cocaine; HR=1.92, 95% CI: 1.39-2.66 for cannabis). When we matched SUD and non-SUD individuals for lifetime comorbidities and adverse socioeconomic determinants of health, the risk for breakthrough infection no longer differed between these populations, except for patients with cannabis use disorder, who remained at increased risk (HR=1.55, 95% CI: 1.22-1.99). The risk for breakthrough infection was higher in SUD patients who received the Pfizer than the Moderna vaccine (HR=1.49, 95% CI: 1.31-1.69). In the vaccinated SUD population, the risk for hospitalization was 22.5% for the breakthrough cohort and 1.6% for the non-breakthrough cohort (risk ratio, RR=14.4, 95% CI: 10.19-20.42), while the risk for death was 1.7% and 0.5% respectively (RR=3.5, 95% CI: 1.74-7.05). No significant age, gender and ethnic disparities for breakthrough infection were observed in vaccinated SUD patients. These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID-19 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non-SUD individuals. The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.
Substance use disorders (SUDs) are common: ~10.8% of adults in the US have had a problem with drug use1, 2. SUDs are often associated with multiple comorbid conditions that are known risk factors for severe outcomes of COVID-19 infection, including cardiovascular, cerebrovascular, immune, hematological, pulmonary, metabolic, oncological, hepatic, renal, infectious, neurological and psychiatric diseases3-11. Additionally, studies from the early pandemic showed that patients with SUDs – including alcohol use disorder, cannabis use disorder, cocaine use disorder, opioid use disorder, and tobacco use disorder – were at increased risk for COVID-19 infection and associated severe outcomes, especially among African Americans6.
In the US, three vaccines have been approved since December 2020: two mRNA vaccines developed by Pfizer-BioNTech and Moderna, and an adenovirus vaccine by Johnson & Johnson. Clinical trial data showed an efficacy of 95% for the Pfizer-BioNTech12, 94.1% for the Moderna13 and 66.3% for the Johnson & Johnson vaccine14 in preventing COVID-19 infection. Clinical trials for COVID-19 vaccines did not explicitly include SUD patients, though they did include – for example, in the clinical trial for Pfizer-BioNTech vaccine – participants with a range of other diseases, including cancers, cardiovascular diseases, human immunodeficiency virus (HIV) infection, and renal diseases12. Currently, there are no systematic studies examining the real-world effectiveness of COVID-19 vaccines in populations with various SUDs. Vaccines are very effective, but breakthrough infections have been recorded15-18, highlighting the need to identify populations that might be most vulnerable, as we have entered a worrisome new phase of the pandemic.
Studies have shown that individuals with compromised immune function, such as organ transplant recipients and cancer patients, have limited rates of SARS-CoV-2 IgG seroconversion19-23. Drugs and alcohol affect immune function, which is likely to contribute to the higher risk for infections in individuals with SUDs3, 6, 24, 25. Thus, we hypothesized that individuals with SUDs could be at increased risk for vaccine breakthrough COVID-19 infection.
In this study, we estimated the risk for breakthrough COVID-19 infection among vaccinated patients with various SUDs compared to matched vaccinated individuals without SUDs. We also examined how the rate of breakthrough cases changed between December 2020 and August 2021.
The study, published last Tuesday in World Psychology, found that those with a substance use disorder (SUD) — a dependence on marijuana, alcohol, cocaine, opioids and tobacco — were more likely to contract the coronavirus after receiving both of their vaccination shots.
Abstract
Individuals with substance use disorders (SUDs) are at increased risk for COVID-19 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID-19, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS-CoV-2 variants. In a population-based cohort study, we assessed the risk, time trends, outcomes and disparities of COVID-19 breakthrough infection in fully vaccinated SUD patients starting 14 days after completion of vaccination. The study included 579,372 individuals (30,183 with a diagnosis of SUD and 549,189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021, and had not contracted COVID-19 infection prior to vaccination. We used the TriNetX Analytics network platform to access de-identified electronic health records from 63 health care organizations in the US. Among SUD patients, the risk for breakthrough infection ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in non-SUD population (p<0.001). Breakthrough infection risk remained significantly higher after controlling for demographics (age, gender, ethnicity) and vaccine types for all SUD subtypes, except for tobacco use disorder, and was highest for cocaine and cannabis use disorders (hazard ratio, HR=2.06, 95% CI: 1.30-3.25 for cocaine; HR=1.92, 95% CI: 1.39-2.66 for cannabis). When we matched SUD and non-SUD individuals for lifetime comorbidities and adverse socioeconomic determinants of health, the risk for breakthrough infection no longer differed between these populations, except for patients with cannabis use disorder, who remained at increased risk (HR=1.55, 95% CI: 1.22-1.99). The risk for breakthrough infection was higher in SUD patients who received the Pfizer than the Moderna vaccine (HR=1.49, 95% CI: 1.31-1.69). In the vaccinated SUD population, the risk for hospitalization was 22.5% for the breakthrough cohort and 1.6% for the non-breakthrough cohort (risk ratio, RR=14.4, 95% CI: 10.19-20.42), while the risk for death was 1.7% and 0.5% respectively (RR=3.5, 95% CI: 1.74-7.05). No significant age, gender and ethnic disparities for breakthrough infection were observed in vaccinated SUD patients. These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID-19 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non-SUD individuals. The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.
Substance use disorders (SUDs) are common: ~10.8% of adults in the US have had a problem with drug use1, 2. SUDs are often associated with multiple comorbid conditions that are known risk factors for severe outcomes of COVID-19 infection, including cardiovascular, cerebrovascular, immune, hematological, pulmonary, metabolic, oncological, hepatic, renal, infectious, neurological and psychiatric diseases3-11. Additionally, studies from the early pandemic showed that patients with SUDs – including alcohol use disorder, cannabis use disorder, cocaine use disorder, opioid use disorder, and tobacco use disorder – were at increased risk for COVID-19 infection and associated severe outcomes, especially among African Americans6.
In the US, three vaccines have been approved since December 2020: two mRNA vaccines developed by Pfizer-BioNTech and Moderna, and an adenovirus vaccine by Johnson & Johnson. Clinical trial data showed an efficacy of 95% for the Pfizer-BioNTech12, 94.1% for the Moderna13 and 66.3% for the Johnson & Johnson vaccine14 in preventing COVID-19 infection. Clinical trials for COVID-19 vaccines did not explicitly include SUD patients, though they did include – for example, in the clinical trial for Pfizer-BioNTech vaccine – participants with a range of other diseases, including cancers, cardiovascular diseases, human immunodeficiency virus (HIV) infection, and renal diseases12. Currently, there are no systematic studies examining the real-world effectiveness of COVID-19 vaccines in populations with various SUDs. Vaccines are very effective, but breakthrough infections have been recorded15-18, highlighting the need to identify populations that might be most vulnerable, as we have entered a worrisome new phase of the pandemic.
Studies have shown that individuals with compromised immune function, such as organ transplant recipients and cancer patients, have limited rates of SARS-CoV-2 IgG seroconversion19-23. Drugs and alcohol affect immune function, which is likely to contribute to the higher risk for infections in individuals with SUDs3, 6, 24, 25. Thus, we hypothesized that individuals with SUDs could be at increased risk for vaccine breakthrough COVID-19 infection.
In this study, we estimated the risk for breakthrough COVID-19 infection among vaccinated patients with various SUDs compared to matched vaccinated individuals without SUDs. We also examined how the rate of breakthrough cases changed between December 2020 and August 2021.
