Chronic opioid use and mortality outcomes in patients admitted with COVID-19: A retrospective cohort study

Background: We hypothesized that chronic opioid users would likely have worse outcomes with COVID-19 infection. Methods: A retrospective review of electronic medical records was conducted for all COVID-19 patients admitted in two large academic hospitals in New York City from March 1, 2020 to June 30, 2020 during the onset of the COVID-19 pandemic. A total of 1,361 patients (1,289 opioid naïve patients, 72 with chronic opioid use) were included. A propensity score matched analysis was used to create a dataset. A logistic regression using the generalized estimating equations method was used to evaluate oxygen requirements including bilevel positive airway pressure (BiPAP), high flow nasal cannula (HFNC), and mechanical ventilation (MV). Cox models with random match pairs were fitted for time spent until hospital discharge and in-hospital mortality. Results: The propensity score matched analysis did not demonstrate a significant difference between the chronic opioid use group vs the opioid naïve group for the use of oxygen support (p = 0.439), BiPAP (p = 0.377), HFNC (p = 0.978), or MV (p = 0.080), and length of stay (LOS) (p = 0.950). There was also no statistically significant finding for reduced need for MV (odds ratio 0.42, 95 percent CI: 0.16-1.11, p = 0.080) and lower in-hospital mortality (hazard ratio 0.75, 95 percent CI: 0.39-1.43, p = 0.378) in the chronic opioid use group; however, future larger studies will be needed. Conclusions: Our study did not demonstrate a significant difference in outcomes in patients with COVID-19 with preadmission chronic opioid use vs opioid naïve patients in oxygen requirements, LOS, MV, or mortality. Future studies are needed to further illustrate the impact of opioids on COVID-19 outcomes.