ABSTRACT
Background: The COVID-19 pandemic has disproportionately impacted people who use illicit drugs and misuse prescription drugs (PWUD), including increased risk for infection with SARS-CoV-2, clinical COVID-19, and poorer health outcomes. The reasons for this disparity are multifactorial and may include numerous social and structural factors. Yet, little is known about COVID-19 testing and vaccinations among PWUD. Methods: This cross-sectional study was conducted in Miami, Florida, USA between March and September 2021 with the support of the National Institutes of Health Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) initiative. Participants had to be 18 years of age and older and willing to be tested for COVID-19. Recruitment included convenience and snowball sampling. The RADx-UP survey (available at https://radx-up.org/) was administered via telephone. Results: A total of 931 participants were enrolled in the study;median age was 59 (53, 64) years, 65.5% were Black, 32.1% Hispanic, and 69.2% had a household income of less than $15,000 in 2019. Nearly a third of participants (32.6%) used drugs. Additionally, 37.6% smoked cigarettes, and 5.2% consumed alcohol for four or more days per week. Twenty percent of participants had never been tested for COVID-19. Of those who reported ever being tested, 14.1% reported ever being positive for SARS-CoV-2, with 67.2% of those having moderate-to-severe symptoms and 26.7% reporting being hospitalized due to COVID-19. Overall, 19 (2.2%) participants tested positive for SARS-CoV-2 at the time of the study, which was more frequent among PWUD than drug non-users (4.2% vs. 1.2%, respectively;p=0.004). PWUD, compared to drug non-users, were less likely to be vaccinated against COVID-19 (66.7% vs. 75.2% for any one dose, respectively;p=0.006). Compared to drug non-users, PWUD had 3.62 (95% CI: 1.41, 9.30;p=0.008) times higher odds of being positive for SARS-CoV-2 based on rt-PCR testing at the time of interview, and 0.66 (95% CI: 0.49, 0.89;p=0.006) times lower odds of being at least partially vaccinated against COVID-19. Conclusion: People who use drugs may be at increased risk of contracting SARS-CoV-2 and developing COVID-19, which could be in part related to lower vaccination rates in addition to comorbidities and lifestyle factors. Testing and immunization plans are needed that are specific for PWUD, considering the barriers and facilitators of this population.