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The Possible Relationship Between the Abuse of Tobacco, Opioid, Or Alcohol with COVID-19

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The Possible Relationship Between the Abuse of Tobacco, Opioid, Or Alcohol with COVID-19 healthcare Review The Possible Relationship between the Abuse of Tobacco, Opioid, or Alcohol with COVID-19 Yusuf S. Althobaiti 1,2,3,* , Maram A. Alzahrani 1, Norah A. Alsharif 1, Nawal S. Alrobaie 1, Hashem O. Alsaab 4 and Mohammad N. Uddin 5 1 Addiction and Neuroscience Research Unit, Health Science Campus, Taif University, Taif 21974, Saudi Arabia; [email protected] (M.A.A.); [email protected] (N.A.A.); [email protected] (N.S.A.) 2 Department of Pharmacology and Toxicology, Health Science Campus, College of Pharmacy, Taif University, Taif 21974, Saudi Arabia 3 General Directorate of Narcotics Control, General Administration for Precursors and Laboratories, Ministry of Interior, Riyadh 11134, Saudi Arabia 4 Department of Pharmaceutics and Pharmaceutical Technology, Taif University, Taif 21944, Saudi Arabia; [email protected] 5 College of Pharmacy, Mercer University, Atlanta, GA 30341, USA; [email protected] * Correspondence: [email protected]; Tel.: +966-545-736-200 Abstract: Introduction: Substance use disorder has been frequently reported to increase the risk of infectious diseases, which might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. Aim: This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different substances (Tobacco, opioid, and Alcohol) with coronavirus disease (COVID-19). Tobacco: Multiple studies confirmed that cigarette smoking affects the respiratory system by increasing the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which have a significant association with COVID-19 infection rate and disease severity. Opioid: Studies conducted regarding the association of opioid use disorder (OUD) and COVID-19 infection severity are limited; however, opioids can lead to both respiratory depression Citation: Althobaiti, Y.S.; Alzahrani, and kidney injuries, causing poor prognosis for those with COVID-19 infections. Alcohol: People M.A.; Alsharif, N.A.; Alrobaie, N.S.; with alcohol use disorders are at risk of developing acute lung injury and severe COVID-19 infection. Alsaab, H.O.; Uddin, M.N. The Possi- Alcohol consumption during the COVID-19 pandemic has two possible scenarios: either increased ble Relationship between the Abuse or decreased based on situations. Conclusion: SUD has been frequently reported to have a positive of Tobacco, Opioid, or Alcohol with relationship with COVID-19 severity Further studies are needed to understand the effects of opioids COVID-19. Healthcare 2021, 9, 2. and alcohol abuse on COVID-19. https://dx.doi.org/10.3390/ healthcare9010002 Keywords: substance use disorder; COVID-19; smoking; opioids; alcohol Received: 3 November 2020 Accepted: 11 December 2020 Published: 22 December 2020 1. Introduction Publisher’s Note: MDPI stays neu- Coronavirus disease 2019 (COVID-19) caused by a recently discovered coronavirus [1], tral with regard to jurisdictional claims can cause potentially severe acute respiratory infections that might lead to death [2]. in published maps and institutional The first case of COVID-19 was reported from Wuhan, China, in early December 2019 [3]. affiliations. Within a month, COVID-19 was declared pandemic due to its rapid transmission across continents, with the number of cases and deaths rising daily [1]. Although most infected individuals exhibit mild illness (81%), 14% have serious symptoms, while 5% have a critical Copyright: © 2020 by the authors. Li- condition. Approximately including invasive ventilation due to acute respiratory distress censee MDPI, Basel, Switzerland. This syndrome [4]. The most common and apparent symptoms for mild to moderate cases are article is an open access article distributed fever, dry cough, and tiredness. In critical cases, the symptoms are severe, such as shortness under the terms and conditions of the of breath, movement or speech loss, and chest pain [1]. On average, symptom onset may Creative Commons Attribution (CC BY) be approximately 5–6 days; however, symptoms can take up to 14 days to appear [1]. Older license (https://creativecommons.org/ patients, as well as patients with underlying medical conditions have been reported to licenses/by/4.0/). have a higher risk for severe illness with coronavirus [5]. Healthcare 2021, 9, 2. https://dx.doi.org/10.3390/healthcare9010002 https://www.mdpi.com/journal/healthcare Healthcare 2021, 9, 2 2 of 12 Substance use disorders (SUD) have been frequently reported to increase the risk of infectious diseases [6]. This increased risk of infectious disease among those addicted to drugs might be owing to the sharing of contaminated inhalation, smoking, vaping, or injection equipment. SUD is among the most prevalent psychiatric disorders worldwide. It is a chronic brain disorder that causes powerful physical and psychological cravings for mind-altering substances [7]. This addiction has several reasons, such as pleasure-seeking, peer-pressure, performance improvement, and self-medication for a preexisting mental disorder [8]. During COVID-19, these substances had reported significant changes in consumption status as a result of pandemic related restrictions. SUD’s major manifestation is compulsive drug use despite severe harmful complications, such as failing in essential tasks, medical illness, or involvement in criminal activity for supporting the addictive behavior [9,10]. Previous studies assumed an increase in the substance of abuse consumption during the COVID-19 related lockdown compared to the period before the lockdown. This review analyzes the recent literature with the aim to put in light the possible relationship between the abuse of different drugs and coronavirus disease (COVID-19). 2. Substances Used Disorders (SUD) and COVID-19 2.1. Tobacco Uses and COVID-19 Cigarette smoking can affect multiple organs, thereby leading to different diseases, and in general, reduces the overall health of smokers [11]. This section discusses different views of researchers on the relationship of tobacco smoking with the severity of COVID-19 infection. A review of studies by public health experts convened by WHO on 29 April 2020 found that smokers are more likely to develop severe disease with COVID-19, compared to non-smokers [12]. Furthermore, Vardavas and Nikitara et al. recent systematic review [12] on five studies [3,13–16] concluded that “smoking is most likely associated with negative progression and adverse outcomes of COVID19”. The largest study population of 1099 patients with COVID-19 was provided by Guan et al. [3] from multiple regions of mainland China. Descriptive results on the smok- ing status of patients were provided for the 1099 patients, of which, 926 had non-severe symptoms and 173 had severe symptoms Among the patients with severe symptoms, 16.9% were current smokers and 5.2% were former smokers, in contrast to patients with non-severe symptoms where 11.8% were current smokers and 1.3% were former smokers. Another study by Zhou et al. [15] studied the epidemiological characteristics of 191 individuals infected with COVID-19, without, however, reporting in more detail the mor- tality risk factors and the clinical outcomes of the disease. Among the 191 patients, there were 54 deaths, while 137 survived. Among those that died, 9% were current smokers com- pared to 4% among those that survived, with no statistically significant difference between the smoking rates of survivors and non-survivors (p = 0.21) with regard to mortality from COVID-19. Similarly, Zhang et al. [13] presented clinical characteristics of 140 patients with COVID-19. The results showed that among severe patients (n = 58), 3.4% were current smokers and 6.9% were former smokers, in contrast to non-severe patients (n = 82) among which 0% were current smokers and 3.7% were former smokers, leading to an OR of 2.23; (95% CI: 0.65–7.63; p = 0.2). Huang et al. studied the epidemiological characteristics of COVID-19 among 41 pa- tients [17]. In this study, none of those who needed to be admitted to an ICU (n = 13) was a current smoker. In contrast, three patients from the non-ICU group were current smokers, with no statistically significant difference between the two groups of patients (p = 0.31), albeit the small sample size of the study. Finally, Liu et al. found among their population of 78 patients with COVID-19 that the adverse outcome group had a signifi- cantly higher proportion of patients with a history of smoking (27.3%) than the group that showed improvement or stabilization (3.0%), with this difference statistically significant at the p = 0.018 level [14]. In their multivariate logistic regression analysis, the history of Healthcare 2021, 9, 2 3 of 12 smoking was a risk factor of disease progression (OR = 14.28; 95% CI: 1.58–25.00; p= 0.018) as shown in Table1. Table 1. Association of smoking with negative progression and adverse outcomes of COVID19. Sample Authors Setting Study Design and Time Smoking and Severity of COVID-19 Size Non-Severe Severe Never n = 926 n = 173 smoked 793 (86.9%) 134 (77.9%) Former Guan et al. [3] China Retrospective 29 January 020 1085 12 (1.3%) 9 (5.2%) smoker Current 108 (11.8%) 29 (16.9%) smoker Current n = 82 n = 58 Retrospective 16 January to 3 smoker 0 (0%) 2 (3.4%) Zhang et al. [13] China 140 February 2020 Former 3 (3.7%) 4 (6.9%) smoker Retrospective from 30 December Current n = 67 n = 11 Liu et al. [14] China 78 2019 to 15 January 2020 smoker 2 (3%) 3 (27.3%) Retrospective multicenter cohort Current n = 54 n = 137 Zhou et al. [15] China 191 study until 31 January 2020 smoker 5 (9%) 6 (4%) Prospective from 16 December Current Non-ICU care ICU care Huang et al. [17] China 41 2019 to 2 January 2020 smoker n = 3 (11%) n = 0 The risk factor relation attributed to that Smoking has been reported to increase the expression of angiotensin-converting enzyme-2 (ACE2) receptors, which has been known to be a target for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and human respiratory coronavirus as shown in Figure1, which leads to an increase in the severity of COVID-19 Symptoms [18].
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