The following is a summary of “Association of substance use with outcomes in mildly ill COVID-19 outpatients,” published in the December 2023 issue of Emergency Medicine by Pobee, et al.

Smoking, alcohol consumption, and non-prescription drug use have been linked to adverse outcomes in hospitalized COVID-19 patients. However, the association between substance use and outcomes in COVID-19 patients visiting the Emergency Department (ED) without requiring hospitalization remains unclear. For a study, researchers sought to investigate whether smoking, alcohol, and non-prescription drug use were associated with worsened COVID-19 outcomes among such ED patients.

A secondary analysis was conducted on data from a clinical trial evaluating early convalescent plasma administration in ED patients within 7 days of mild COVID-19 symptom onset. The study enrolled 511 participants aged 50 or older with one or more risk factors for severe COVID-19. The primary outcome was disease progression within 15 days post-randomization, defined as hospital admission, seeking emergency/urgent care, or death without hospitalization. Secondary outcomes included no hospitalization within 30 days, worsening symptoms on the 5-category COVID-19 outpatient scale within 15 days, and all-cause mortality. Substance use was categorized as either use or non-use based on participant self-report, and logistic regression models assessed the association between substance use and outcomes.

The study included 511 patients with a mean age of 52 years; the majority were females (54%). Approximately 42% were non-Hispanic Whites, 30% were Hispanics, and 20% were non-Hispanic Blacks, with smaller proportions of other races. Tobacco use was reported by 30% of patients, while alcohol and non-prescription drug use were less common (7% and 6%, respectively). Tobacco and non-prescription drug use were associated with an increased risk of meeting the primary outcome ((tobacco: adjusted odds ratio [aOR] =2.08; 95% CI: 1.37–3.15) and (drug: aOR =2.41; 95%CI: 1.17–5.00)) and increased risk for symptom worsening on the 5-category COVID-19 outpatient scale ((tobacco: aOR = 1.62; 95%CI: 1.09–2.42) and (drug: aOR = 2.32 95% CI: 1.10–4.87)) compared to non-use after adjusting for age, sex, plasma administration, and comorbidity.

Tobacco and non-prescription drug use, but not alcohol use, were associated with worsened COVID-19 outcomes in ED patients not requiring initial hospitalization. Further research is warranted to determine the specific quantity, duration, and types of substance use that may exacerbate COVID-19.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723004886