Background: Poor outcomes of COVID-19 have been reported in older males with medical comorbidities
including substance use disorder. However, it is unknown whether there is a difference in COVID-19
treatment outcomes between patients who are current cannabis users, excessive alcohol drinkers and
those who use a known hazardous stimulant such as methamphetamine (METH).
Methods: Electronic medical records (EMR) of COVID-19 patients with current METH (n=32), cannabis
(n=46), and heavy alcohol use (n=44) were reviewed. COVID-19 infection was confirmed by positive SARSCoV-
2 PCR test, current drug use was confirmed by positive urine drug testing, and alcohol use was
identified by a blood alcohol concentration greater than 11 mg/dl. Multivariate linear regression models
as well as the firth logistic regression models were used to examine the effect of substance use group
(METH, cannabis, or alcohol) on treatment outcome measures.
Results: A total of 122 patients were included in this analysis. There were no significant differences found
between drug groups in regards to key SARS-CoV-2 outcomes of interest including ICU admission, length
of stay, interval between SARS-CoV-2 positive test and hospital discharge, delirium, intubation and
mortality after adjusting for covariates.. About one-fifth (21.9% in METH users, 15.2% in cannabis users,
and 20.5% in alcohol users) of all patients required ICU admission. As many as 37.5% of METH users,
23.9% of cannabis users, and 29.5% of alcohol users developed delirium (P=0.4). There were no significant
differences between drug groups in COVID-19 specific medication requirements. Eight patients in total
died within 10 months of positive SARS-CoV-2 PCR test. Two patients from the METH group (6.3%), two
patients from the cannabis group (4.3%), and four patients from the alcohol group (9.1%) died.
Discussion: The study outcomes may have been affected by several limitations. These included the
methodology of its retrospective design, relatively small sample size, and the absence ofa COVID-19
negative control group. In addition, there was no quantification of substance use and many covariates
relied on clinical documentation or patient self-report. Finally, it was difficult to control for all potential
confounders particularly given the small sample size.
Conclusion: Despite these limitations, our results show that current METH, cannabis, and heavy alcohol
users in this study have similar treatment outcomes and suffer from high morbidity including in-hospital
delirium and high mortality rates within the first-year post COVID-19. The extent to which co-morbid
tobacco smoking contributed to the negative outcomes in METH, cannabis, and alcohol users remains to
be investigated.

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