Factors Associated with SARS-CoV-2 Infection and Severe COVID-19 Disease Among Individuals Prescribed Opioid Agonist Treatment in Scotland

Author: Megan Glancy Alan Yeung Andrew McAuley Norah Palmateer Lee Barnsdale Jen Bishop Jaroslaw Lang Bob Taylor Sharon Hutchinson Sharon

Theme: Epidemiology & Public Health Research Year: 2022

Among people receiving opioid agonist treatment (OAT), the risk of SARS-CoV-2 infection and
associated severe outcomes may be higher owing to underlying health problems and vulnerable
social circumstances. Our aim was to determine whether individuals with recent exposure to OAT,
compared to those with past exposure, were at any different risk of (i) testing positive and (ii)
hospitalisation or death with COVID-19.
Records on individuals prescribed OAT between 2015–2020 in Scotland (not known to have died by
March 2020) were linked to healthcare (including vaccine, hospitalisation and deaths) data at Public
Health Scotland up to December 2021. Multi-variate logistic regression was used to estimate
associations between recent OAT prescription (defined as in the previous two months), versus past
prescription (defined as 2–5 years ago), and (i) testing positive among those tested, and (ii)
hospitalisation/death among those who tested positive, adjusting for covariates (age, sex, region,
deprivation, comorbidities and vaccination) and stratified by epidemic ‘wave’ periods.
Among the OAT cohort (n = 36,093), 52.9% (19,081) had ever been tested, 8.3% (2,996) had ever
tested PCR positive and 1.5% (555) were hospitalised/died with COVID-19 (relating to 18.5% of those
diagnosed with infection). Recent OAT prescription was associated with lower odds of testing
positive (aOR in waves 1–3: 0.52 (95% CI: 0.47, 0.57); wave 1: 0.6 (0.37, 1.01); wave 2: 0.5 (0.42,
0.59); wave 3: 0.62 (0.56, 0.69)), but higher odds of hospitalisation/death (waves 1–3: 2 (1.56, 2.58);
wave 1: 3.78 (0.69, 22.91); wave 2: 2.59 (1.62, 4.23); wave 3: 1.8 (1.31, 2.5)).
We found evidence to suggest that recent OAT use may be protective against SARS-CoV-2 infection
but not against the consequences of infection once diagnosed. Additional effort is warranted to help
prevent the severe consequences of SARS-CoV-2 among people on OAT.
Disclosure of Interest Statement:
SJH received Honoria from Gilead unrelated to this work; all remaining authors have nothing to

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