SARS-CoV-2 Vaccine Uptake and Risks of Severe COVID-19 Disease Among People Prescribed Opioid Agonist Therapy in Scotland

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

Theme: Epidemiology & Public Health Research Year: 2022

People who use drugs are at potentially increased risk of severe outcomes from COVID-19 due to
their expected higher prevalence of comorbidities compared with the general population. We aimed
to examine the uptake of vaccination for SARS-CoV-2 and risks of severe COVID-19 disease among
people with a recent history of opioid agonist therapy (OAT) in Scotland.
40,654 individuals prescribed OAT (either methadone, buprenorphine or buprenorphine-naloxone)
between 2015-2020 were linked to other healthcare (including vaccination, hospital and deaths)
data at Public Health Scotland up to 22nd February 2022. Vaccine-uptake in the OAT cohort was
compared to general population controls matched for age, sex and deprivation profile. In each
epidemic wave of the pandemic, the risk of a severe case of COVID-19 (defined as critical care or
death and compared to general population matched controls) associated with prescription of OAT in
the last five years was examined using conditional logistic regression.
By 22nd February 2022, vaccine uptake was lower in the surviving OAT cohort (67% first, 53% second
and 29% third/booster dose) compared to matched controls (76%, 72% and 56%, respectively).
Across all four waves of the pandemic, those prescribed OAT within the last 5 years were at
increased risk of severe COVID-19 disease (relative risks in wave 1: 3.6, 95% CI 2.1-6.1; wave 2: 2.9,
2.0-4.2; wave 3: 3.8, 2.6-5.6; wave 4: 5.7, 3.3-10.0); additional adjustment for comorbidity and
vaccination status attenuated the risk (wave 4: 2.7, 1.4-5.0).
The gap in vaccine uptake for those prescribed OAT, compared to the general population, has
widened with the roll-out of each additional recommended dose, and exacerbated the risk of severe
COVID-19 disease in this group as the pandemic has evolved. Our data highlight the need for
additional efforts to improve vaccine coverage among people who use drugs.
Disclosure of Interest Statement:
All authors have nothing to disclose.

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