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).

A case-control design was used to examine vaccine uptake in those prescribed OAT compared to the general population, and association between severe disease and OAT. In both analyses, ten 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.

Vaccine uptake was markedly lower in the OAT cohort (dose 1: 67%, dose 2: 53%, and dose 3: 31%) compared to matched-controls (76%, 72% and 57%, respectively). Those prescribed OAT within the last 5 years, compared to those not prescribed, had increased risk of severe COVID-19 (RR 3.38, 95% CI 2.75-4.15), particularly in the 4th wave (RR 6.58, 95% CI 4.20-10.32); adjustment for comorbidity and vaccine status attenuated this risk (aRR 2.43, 95% CI 1.95-3.02; wave 4 aRR 3.78, 95% CI 2.30-6.20). Increased risk was also observed for those prescribed OAT previously (>3 months ago) compared with recently (aRR 1.74, 95% CI 1.11-2.71).

The widening gap in vaccine coverage for those prescribed OAT, compared to 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.


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Yeung, A., Wilkinson, M., Bishop, J., Taylor, B., Palmateer, N., Barnsdale, L., Lang, J., Cameron, C., McCormick, D., Clusker, T., McAuley, A. & Hutchinson, S. 2024, 'SARS-CoV-2 vaccine uptake and risks of severe COVID-19 disease among people prescribed opioid agonist therapy in Scotland', Journal of Epidemiology and Community Health. https://researchonline.gcu.ac.uk/en/publications/572aa7bf-2bc4-49e9-8850-264f6fbb874f

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Last updated: 14 March 2024
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