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The COVID-19 pandemic presents unique challenges for people with substance use disorders and in recovery. The following resources may help.

From Dr. Nora Volkow, NIDA Director

FAQs on COVID-19 and Addiction/Substance Use Disorder

COVID-19: What people with an addiction or a substance use disorder should know

Are people who have an addiction or a substance use disorder (SUD) at greater risk for contracting COVID-19?

Much remains to be learned about COVID-19, including how it affects people who smoke or vape, or who have an SUD. However, it is known that these individuals are more likely to have suppressed immune systems, are at greater risk for respiratory infections, and may have lung and heart diseases. This could present a greater risk for COVID-19 infection, or more serious cases of the disease.

Why might COVID-19 be a concern for those who smoke or vape?

We know that cigarette smoking suppresses the immune system, increases the risk of respiratory infections including pneumonia, and causes heart and lung diseases. This could potentially put people who smoke cigarettes at a greater risk of contracting COVID-19, and those infections could be more severe. Researchers are working to better understand the relationship between COVID-19 and smoking.

E-cigarette use can expose the lungs to toxic chemicals, but it is not clear if that increases the risk of contracting the virus that causes COVID-19 and if the symptoms could be more severe. However, many e-cigarette users are current or former smokers. Vaping devices or e-cigarettes should never be used by youth, young adults, and pregnant women, or adults who do not currently use tobacco products.

Why is COVID-19 a special concern for people who have an opioid use disorder (OUD)?

Because opioids negatively impact lung and heart health, people who use opioids at high doses may be more susceptible to COVID-19 and the illness may be more severe. People who have an OUD also face separate challenges to their respiratory health. Opioids act in the brainstem to slow breathing, which not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). While brain cells can function for short periods of low oxygen, longer periods with low or no oxygen can be especially damaging to the brain. Chronic respiratory disease can increase deadly overdose risk among people taking opioids, and diminished lung capacity from COVID-19 could similarly endanger this group.

Could methamphetamine use put people at risk?

Yes, methamphetamine constricts the blood vessels, which could contribute to lung and respiratory damage and pulmonary hypertension in people who use it.

Are there other risks associated for people with an SUD?

Access to health care may be limited in some locations, and people with addiction may not be able to get care when they need it. If hospitals and clinics are pushed to their capacity, it could be that people with addiction—who are already often stigmatized and underserved by the health care system—will experience even greater barriers to treatment for COVID-19.

A high percentage of individuals with an SUD experience homelessness, and vice versa. Among countless other difficulties and risks faced by those who have housing instability, increased risk for disease transmission in homeless shelters is particularly important now.

The same is true of incarceration. More than half of U.S. prisoners have an SUD, and prison populations are at great risk for disease transmission during this pandemic.

What should people keep in mind about stigmatizing those with an SUD?

People with an SUD may already be marginalized by health care services, largely because of stigma. Much of this stigma is based on the mistaken but continuing belief that addiction is the result of weak character and poor choices. But science has clearly shown it to be a disorder that results from changes in brain circuitry.

It is important that all people with an SUD be treated with compassion and dignity.

How is the COVID-19 crisis impacting people in treatment for an SUD or those currently in recovery?

Those in treatment are uniquely challenged by physical distancing measures. Self-quarantine and other public health measures may disrupt access to medications and other support services. Federal agencies have taken steps to expand access to needed medications during the pandemic.

For those in recovery from an SUD, social support is crucial since social isolation is a risk factor for relapse. Even though the physical distancing measures being implemented nationwide are important for reducing disease transmission, they may be especially difficult for people in recovery because they limit access to meetings of peer-support groups and other sources of social connection. Although face-to-face interaction is a key feature of recovery support, virtual meetings may be useful for those with access to the internet.

If challenges to accessing medications exist, could this impact the lives of people with an OUD?

Possibly. Lack of access to medications for treating OUD may increase the likelihood of relapses and opioid overdoses. Due to physical distancing, many people with OUD may not have a family member or friend with them to give naloxone in the event of an overdose, resulting in more fatalities.

Increased burden on emergency departments from COVID-19 may mean that people presenting with opioid overdose are less likely to be initiated on medication therapies, which is an important part of lessening the effects of the opioid crisis.

What should I do during this pandemic if I have an SUD?

Here are some suggestions and resources:

  • Stay as safe as possible from contracting COVID-19 by following the U.S. Centers for Disease Control and Prevention (CDC) COVID-19 guidance.
  • Call your doctor if you experience symptoms of COVID-19. Individuals with an SUD may be at higher risk for serious effects.  
  • If you are in treatment for substance use, maintain contact with your provider. Learn how the necessary COVID-19 distancing policies impact your treatment to ensure you continue with care.
  • It is normal to experience stress during this difficult time, but stress can also increase substance use. Effective coping strategies and virtual recovery meetings can reduce the impact of stress and fear, and alleviate anxiety, depression, and other difficult emotions.

How do I help a loved one with an SUD, or who is in recovery, during this difficult time?

While it is normal to experience stress and fear during this difficult time, changes in routine and physical distancing policies may be especially hard for people with an SUD. Those in recovery may face heightened urges to use substances and could be at increased risk for relapse.

  • If you know someone who is experiencing or recovering from an SUD, now may be a good time to reach out to them to see how they are and to remind them that they are loved.
  • You can also encourage your loved one to use effective coping strategies to reduce the impact of stress and fear, and alleviate anxiety, depression, and other difficult emotions.
  • If your loved one is increasing their use of substances or decreasing treatments during this pandemic, help them connect to supportive resources, including virtual recovery meetings. Many are easy-access virtual resources to help those with an SUD and their loved ones, including:
    • Substance Abuse and Mental Health Services Administration (SAMHSA)
    • National Institute on Alcohol Abuse and Alcoholism (NIAAA)
    • Addiction Policy Forum and CHESS Health
      • Connections App. Free research-based smartphone app to help people with recovery from substance use.
    • Center on Addiction
    • Faces and Voices of Recovery
      • Faces & Voices of Recovery is dedicated to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs, their families, friends and allies into recovery community organizations and networks.
    • Shatterproof
    • Unity Recovery, WeConnect, SOS Recovery, and Alano Club
  • If your loved one is in crisis, call the National Suicide Prevention Lifeline (Lifeline) at 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741). Both services are free and available 24 hours a day, seven days a week. The deaf and hard of hearing can contact the Lifeline via TTY at 1-800-799-4889. All calls are confidential.
  • Contact social media outlets directly if you are concerned about a friend’s social media updates or dial 911 in an emergency. Learn more on the Lifeline’s website or the Crisis Text Line’s website.

These FAQs are also available as a PDF -  Download FAQs on COVID-19 and Addiction/Substance Use Disorder (PDF, 42KB)

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This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses.

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