Persons with substance use disorders (SUD) in the United States have been disproportionately affected by the Covid-19 pandemic — not only are they, like patients with other chronic dis-eases such as diabetes, at increased risk for se-vere disease and death due to Covid,1 but data show that overdose deaths have increased during the pandemic.2 Furthermore, there is significant overlap between populations with SUD and those facing housing instability and homeless-ness, domestic and sexual violence, and incar-ceration — social conditions that increase Covid risk.3 To date, only persons who use tobacco, not substances such as opioids, are being prioritized for early vaccination.4