(31) COVID-19 Vaccine Uptake and Attitudes Among People with OUD

Background

People who use drugs(PWUD)are disproportionately affected by the COVID-19 pandemic. Comorbidities, housing instability, and social distancing difficulties often place people with opioid use disorder(OUD)at higher risk for contracting COVID-19, making them prime candidates to benefit from the COVID vaccine(1). Since the advent of the COVID-19 vaccine, many Americans have been hesitant to receive it, a skepticism common in people with OUD and in homeless populations(2). However, reasons underlying this skepticism and vaccine hesitancy in these populations are not well described. We aimed to assess COVID vaccine uptake, as well as attitudes and experiences during the COVID pandemic, among individuals with OUD.

Methods

Participants were enrolled in the LOOP study, a prospective cohort study of individuals with OUD within 3 years in Washington,DC and Baltimore,MD. Participants were administered surveys assessing demographics, attitudes, experiences, and behaviors during the COVID-19 pandemic since March 2020. Fisher’s exact test was used for statistical analysis.

Results

Of 189 participants surveyed, 120(63.5%)were male, median 57 years, 145(76.7%)Black race, and 102(54%)stably housed. At time of most recent survey, 128(67.7%)reported drug use in the past 6months, and 169(89.4%)were on medication for opioid use disorder(MOUD).

17(9%)participants reported being diagnosed with COVID at some point during the pandemic. 98(51.9%)participants knew someone who had been diagnosed with COVID, and 36(19%)participants knew someone who died of COVID. 137(72.5%)participants reported receiving a COVID test.

Of 142 participants administered a COVID questionnaire after March 30,2021, 100(70.4%)participants reported receiving a COVID vaccine, which was associated with ever receiving a COVID test(n=86, 86% of vaccinated, p=0.0113). Receipt of COVID vaccine was not associated with housing status, being on MOUD, recent drug use, ever having COVID, knowing someone with COVID, or knowing someone who died of COVID(all p>0.05).

42(29.6%)participants reported that they did not get vaccinated. Reasons for non-vaccination included being unsure of the safety of the vaccine(27,64.3%)and being skeptical of the COVID vaccines in general(42.8%,18), as well as specific skepticism about the government’s intentions with the vaccine and speed of the vaccine rollout. Only 1(2%)participant identified transportation as a barrier to vaccination.

70 participants surveyed about vaccine receipt had also completed a questionnaire about COVID vaccine attitudes 12 months prior, when vaccines were not yet approved by the FDA. Of 43(61.4%)people who previously expressed interest in future vaccination, 38(88.4%)reported eventual vaccine receipt. In contrast, among 27 people who previously expressed being unwilling/unsure about future vaccination, only 16(59.3%)reported vaccine receipt(p=0.008).

Conclusions

Among a population of participants with OUD, we identified a cohort of people who were largely vaccinated against COVID. While vaccine uptake was not associated with demographic factors or drug use behaviors, prior stated reluctance to receive the vaccine was associated with non-uptake. Reasons for non-uptake predominantly included concern about safety and mistrust of the system rather than logistical barriers. Distrust of the medical system may result from many factors, including historical mistreatment and trauma. These data reinforce the importance of patient-centered measures to foster trust among PWUD/OUD, including targeted strategies to address vaccine concerns and skepticism in order to reduce further COVID-related harms in this critical and marginalized population.

References: References
1.Sandra, Larson. “Why We Should Prioritize People with SUD for COVID-19 Vaccination.” HealthCity, https://healthcity.bmc.org/policy-and-industry/why-we-should-prioritize-people-sud-covid-19-vaccination.
2.Brown, Frederic. “Among Homeless Populations, a Deep Mistrust of Vaccines. Here's How Cities Are Intervening.” NBCNews.com, NBCUniversal News Group, 6 Mar. 2021, https://www.nbcnews.com/news/us-news/among-homeless-populations-deep-mistrust-vaccines-here-s-how-cities-n1259761.
3. Sarah Watson // August 11, 2021. “City Program Employs Homeless People to Help Promote Vaccinations in Shelters and on the Streets.” Street Sense Media, 14 Sept. 2021, https://www.streetsensemedia.org/article/peer-education-shelter-pep-v-social-distancing/#.YervfhdKjyg.