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Table 1 Summary of risk factors for COVID-19 in people affected by SUD

From: “The post-COVID era”: challenges in the treatment of substance use disorder (SUD) after the pandemic

Substance-related factors [2,3,4,5,6,7] Contextual and pattern of use related factors [8, 9]
• A protective effect of nicotine has been claimed, but a systematic review (5 studies, n = 1358) has shown that smoking is associated with adverse outcomes of COVID-19. Another study (169 hospitals, n = 8910) found the risk of death for current smokers during hospitalization due to COVID-19 79% higher than in non-smokers.
• Alcohol use, especially heavy use, weakens the innate and acquired immune systems, thus increasing the risk of infections such as tuberculosis, HBV, HCV, HIV-AIDS, or COVID-19, and worsening the course of the disease. Heavy drinking is a well-established risk factor for acute respiratory distress syndrome.
• Regular cannabis use is associated with coughing and other respiratory symptoms.
• Lung injuries related to vaping and/or smoking.
• Lack of access to hand washing, disinfecting wipes, and personal protective equipment (PPE), and overcrowding among certain groups of people who use drugs (e.g., those in incarceration, homelessness).
• Pulmonary hypertension associated with methamphetamine use.
• Compromised immune function.
• Stigma of drug and alcohol use as a barrier to accessing healthcare.
• Sharing cigarettes, drinks, or needles is high-risk behaviors for becoming infected with SARS-CoV-2.
• Lockdown has had an impact on illicit drug supplies, with a subsequent impact on behaviors of people who use substances.