People With Substance Use Disorders Face Barriers To Getting COVID Vaccine

As more states begin making COVID-19 vaccinations available to all adults over 16, many health care experts who work with people with substance use disorder (SUD) worry that some of their patients may not sign up for COVID-19 vaccines or will refuse a vaccine, if offered.  

People with SUD can be at a higher risk for infections, including COVID-19. Even though getting vaccinated is critical for at-risk populations, there are several factors and barriers that can influence a person's ability or willingness to get vaccinated.

What Research Shows

A small study published in March in the journal Drug and Alcohol Dependency that surveyed COVID-19 vaccine willingness among people with substance abuse disorder (SUD) found that 56% of the 87 participants were uncertain about the vaccine, unwilling to take the vaccine, or would consider it after a delayed period of time.

“I believe that individuals with substance use disorders should be specifically reached out to discuss getting COVID vaccinations,” Eric Weintraub, MD, director of the division of alcohol and drug abuse at the University of Maryland School of Medicine, tells Verywell.

Weintraub emphasizes that outreach needs to focus on people both in treatment and not receiving treatment. "I discuss vaccinations with every patient that I see," Weintraub says. "For those not in treatment, we should be developing strategies to educate them about the vaccination process.” 

SUD and Risk for Severe COVID-19

Compounding the issue of hesitancy is the fact that people with SUD appear to be at increased risk of severe disease if they contract COVID-19. A study published in September 2020 in the journal Molecular Psychiatry found that people with SUD are more susceptible to COVID-19 and its complications. 

The study authors analyzed the electronic health records of millions of patients in the United States and found that while people with SUD comprised only 10.3% of the study participants, they represented 15.6% of the COVID-19 cases.

“The lungs and cardiovascular system are often compromised in people with SUD, which may partially explain their heightened susceptibility to COVID-19,” Nora Volkow, MD, director of the National Institute on Drug Abuse and a co-author of the study, tells Verywell. “Another contributing factor is the marginalization of people with addiction, which makes it harder for them to access healthcare services.”

The study also found that Black people with a recent opioid use disorder diagnosis were more than four times more likely to develop COVID-19 compared to White people with a recent opioid use disorder diagnosis.

The researchers also noted that hypertension, diabetes, cardiovascular diseases, and renal diseases—known risk factors for COVID-19—were more prevalent among Black individuals than White people with opioid use disorder.

Barriers to Vaccine Access

In a January article in the New England Journal of Medicine, Joshua Barocas, MD, an assistant professor of medicine at the Boston University School of Medicine, wrote about the additional barriers to getting the vaccine for people with SUD, including the “significant overlap between populations with SUD and those facing housing instability and homelessness, domestic and sexual violence, and incarceration—social conditions that increase COVID risk."  

Barocas went on to say that to develop effective vaccination strategies, "health professionals must first contend with this population’s mistrust of us."

For people with SUD, Barocas points out that the medical profession has "often fueled the fire of stigma, driving people away and cementing distrust." As a result, some people with SUD "have turned to illegitimate information sources and have fallen prey to conspiracy theories."

Taking these factors into account, Barocas concluded that it's "naive to believe that people with SUD will unquestioningly and willingly line up for vaccinations.” 

According to Barocas, additional vaccine access issues for people with SUD include:

• Inadequate access to transportation and technology, which limits the ability to reach vaccine administration sites
• Lack of access to technology, which makes it more difficult for vaccination sites to track people and administer second doses
• Unstable housing and food insecurity can be more immediate problems for people with SUD than accessing a COVID-19 vaccine

Barocas also recommends that trusted sources, such as peer navigators, recovery coaches, and harm-reduction service providers (such as staff at syringe exchange programs) talk to people with SUD about COVID-19 vaccines. 

Helping People With SUD Get Vaccinated 

In March, a new vaccination initiative was announced by two nonprofit groups serving people with SUD: The Foundation for Opioid Response Efforts (FORE), which is based in New York City, and the Addiction Policy Forum (APF), which is based in Bethesda, Maryland.

The program was launched through a webinar in March that featured Anthony Fauci, MD, head of the National Institute of Allergy and Infectious Diseases (NIAID) and chief medical adviser on the pandemic to President Biden.

Roughly 4,000 people signed up for the webinar, including many people with SUD as well as their family members and caregivers. As with the general population, many of the participants' questions focused on vaccine safety and side effects.  

Help from Vaccine Navigators

Jessica Hulsey, CEO of the Addiction Policy Forum, tells Verywell that the program, which is being funded by a grant of more than $125,000 from FORE, will provide trained "vaccine navigators" to help schedule vaccine appointments and address concerns about taking the vaccine among people with substance use disorder over the next few months.

Navigators can help people find vaccination sites, identify available appointments, and schedule vaccine appointments. “We know how time-consuming finding a vaccine can be, and what to make it as easy as possible for everyone involved in dealing with SUD,” Hulsey says.

If appropriate at the time of the call, vaccine navigators can also share information about free, confidential support, evidence-based information, and connection to local addiction treatment and recovery resources. 

Vaccine navigators will also actively reach out to people with SUD through APF’s 50 state chapters and affiliated community-based agencies across the country, which include underserved people in Black, Latinx, LGBTQ, and tribal communities.