{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:05:27Z","timestamp":1788433527746,"version":"build-2803163510"},"reference-count":49,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["World Psychiatry"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:p>Individuals with substance use disorders (SUDs) are at increased risk for COVID\u201019 infection and for adverse outcomes of the infection. Though vaccines are highly effective against COVID\u201019, their effectiveness in individuals with SUDs might be curtailed by compromised immune status and a greater likelihood of exposures, added to the waning vaccine immunity and the new SARS\u2010CoV\u20102 variants. In a population\u2010based cohort study, we assessed the risk, time trends, outcomes and disparities of COVID\u201019 breakthrough infection in fully vaccinated SUD patients starting 14 days after completion of vaccination. The study included 579,372 individuals (30,183 with a diagnosis of SUD and 549,189 without such a diagnosis) who were fully vaccinated between December 2020 and August 2021, and had not contracted COVID\u201019 infection prior to vaccination. We used the TriNetX Analytics network platform to access de\u2010identified electronic health records from 63 health care organizations in the US. Among SUD patients, the risk for breakthrough infection ranged from 6.8% for tobacco use disorder to 7.8% for cannabis use disorder, all significantly higher than the 3.6% in non\u2010SUD population (p&lt;0.001). Breakthrough infection risk remained significantly higher after controlling for demographics (age, gender, ethnicity) and vaccine types for all SUD subtypes, except for tobacco use disorder, and was highest for cocaine and cannabis use disorders (hazard ratio, HR=2.06, 95% CI: 1.30\u20103.25 for cocaine; HR=1.92, 95% CI: 1.39\u20102.66 for cannabis). When we matched SUD and non\u2010SUD individuals for lifetime comorbidities and adverse socioeconomic determinants of health, the risk for breakthrough infection no longer differed between these populations, except for patients with cannabis use disorder, who remained at increased risk (HR=1.55, 95% CI: 1.22\u20101.99). The risk for breakthrough infection was higher in SUD patients who received the Pfizer than the Moderna vaccine (HR=1.49, 95% CI: 1.31\u20101.69). In the vaccinated SUD population, the risk for hospitalization was 22.5% for the breakthrough cohort and 1.6% for the non\u2010breakthrough cohort (risk ratio, RR=14.4, 95% CI: 10.19\u201020.42), while the risk for death was 1.7% and 0.5% respectively (RR=3.5, 95% CI: 1.74\u20107.05). No significant age, gender and ethnic disparities for breakthrough infection were observed in vaccinated SUD patients. These data suggest that fully vaccinated SUD individuals are at higher risk for breakthrough COVID\u201019 infection, and this is largely due to their higher prevalence of comorbidities and adverse socioeconomic determinants of health compared with non\u2010SUD individuals. The high frequency of comorbidities in SUD patients is also likely to contribute to their high rates of hospitalization and death following breakthrough infection.<\/jats:p>","DOI":"10.1002\/wps.20921","type":"journal-article","created":{"date-parts":[[2021,10,8]],"date-time":"2021-10-08T08:28:59Z","timestamp":1633681739000},"page":"124-132","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":122,"title":["Increased risk for <scp>COVID<\/scp>\u201019 breakthrough infection in fully vaccinated patients with substance use disorders in the United States between December 2020 and August 2021"],"prefix":"10.1002","volume":"21","author":[{"given":"Lindsey","family":"Wang","sequence":"first","affiliation":[{"name":"Center for Artificial Intelligence in Drug Discovery, School of Medicine Case Western Reserve University  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"QuanQiu","family":"Wang","sequence":"additional","affiliation":[{"name":"Center for Artificial Intelligence in Drug Discovery, School of Medicine Case Western Reserve University  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela B.","family":"Davis","sequence":"additional","affiliation":[{"name":"Center for Community Health Integration, School of Medicine Case Western Reserve University  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora D.","family":"Volkow","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse National Institutes of Health  Bethesda MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rong","family":"Xu","sequence":"additional","affiliation":[{"name":"Center for Artificial Intelligence in Drug Discovery, School of Medicine Case Western Reserve University  Cleveland OH USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health","author":"Abuse Substance","year":"2020"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.2132"},{"key":"e_1_2_6_4_1","unstructured":"National Institute on Drug Abuse. 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