Trust in a COVID-19 vaccine among people with substance use disorders.

Dear Editor,

Data suggest that individuals with substance use disorders (SUDs) are at elevated risk of COVID-19 (Wang et al., 2020). Following issues of scarcity and prioritization in access (Hert et al., 2021), addressing vaccine distribution and readiness is critical for reducing the burden of the pandemic on this population (Warren et al., 2020). Given that high-risk or episodic substance use is associated with decreased likelihood of receipt of other preventive vaccines (Lasser et al., 2011), addressing both systemic and individual factors is key to promoting vaccination. Here we highlight the need to consider individuals with SUDs concerning not only vaccine access, but also trust and readiness.

COVID-19 vaccine readiness

The Addiction Policy Forum conducted structured interviews with 87 US-based individuals (54 % female, mean age 43 years (SD = 12.8)) impacted by SUDs (18 % currently using substances, 14 % in treatment, 76 % in recovery, non-exclusive self-report) between September 10 and 27, 2020 with IntegReview IRB approval. Participants were recruited via the Addiction Policy Forum’s US network of patients, families, and survivors of SUDs. One-on-one interviews were conducted by 3 trained Addiction Policy Forum staff via telephone and video conferencing. When prompted about willingness to take a COVID-19 vaccine, responses encompassed immediate readiness (45 %), readiness after a delay (8 %), uncertainty (23 %), and unwillingness (25 %). Those who were hesitant cited a “rushed” process for development, possibilities of adverse effects, interactions with pre-existing conditions, and/or skepticism that they were at high risk for COVID-19 itself, with the following specific comments:

“No. I would rather catch it, I don’t trust the government, I dunno, it’s so new I don’t want to be on the receiving end of it, I’m not high risk or anything. If I did catch it, I don’t foresee it being fatal for me. I don’t get flu vaccines.” – in recovery

“Yes, if my personal doctor recommends it.” – receiving treatment

“Absolutely, once it's been vetted.” – currently using

Trust and readiness

The APF prompted participants on sources of information in which they trusted when making health decisions. Most reported they trusted their doctor in making their healthcare decisions, even among those who were hesitant towards a vaccine. Family was cited next most frequently, with participants reporting overall reliance on multiple sources (physicians and health workers, social media, television/newspapers, radio, official website(s), NIH/CDC, family, research data/medical journals, internet). Few participants reported lack of trust in any sources.

We also prompted individuals about their willingness to receive multi-dose vaccines. While this did not change overall willingness or trust for the majority of respondents, some cited barriers to vaccine uptake that would only increase with series vaccination and were exacerbated during COVID-19. These included difficulties scheduling appointments given work and childcare obligations, and restrictions in access to clinics due to COVID-19.

Conclusions

Distribution programs, especially for series vaccines, may encounter significant barriers from people with SUDs. Interventions that have been developed to promote vaccination uptake among people with mental illness, including both educational components and distribution programs, warrant consideration among people with SUDs (Miles et al., 2020). These perspectives highlight that physician-patient relationships are important to ensuring people with SUDs trust in COVID-19 vaccines as they are distributed.

Funding

Supported in part by the National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), U.S. Department of Health and Human Services (HHS).

Contributors statement

BK and JH contributed to project administration, data curation, and data collection. BK, JH, and AM contributed to data curation and coding of interviews. JH contributed funding. MP and JH contributed supervision and conceptualization. AM prepared the first draft. All authors discussed the results and contributed review and editing.

Declaration of Competing Interest

The authors declare that they have no conflict of interest with respect to the content of this manuscript. The authors alone are responsible for the content and writing of the manuscript. Dr. Potenza has the following disclosures. He has consulted for and advised Opiant Pharmaceuticals, Idorsia Pharmaceuticals, AXA, Game Day Data, and the Addiction Policy Forum; has received research support from the Mohegan Sun Casino, the Connecticut Council on Problem Gambling, and the National Center for Responsible Gaming; has participated in surveys, mailings or telephone consultations related to drug addiction, impulse control disorders or other health topics; and has consulted for law offices and gambling entities on issues related to impulse control or addictive disorders. The Addiction Policy Forum is a 501 (c) (3) organization based in North Bethesda, MD. The Addiction Policy Forum was founded in 2015 to help, through science and advocacy, patients and families impacted by addiction.