Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems

Abstract

People with opioid use disorder are vulnerable to disruptions in access to addiction treatment and social support during the COVID-19 pandemic. Our study objective was to understand changes in emergency department (ED) utilization following a nonfatal opioid overdose during COVID-19 compared to historical controls in 6 healthcare systems across the United States.Methods: Opioid overdoses were retrospectively identified among adult visits to 25 EDs in Alabama, Colorado, Connecticut, North Carolina, Massachusetts, and Rhode Island from January 2018 to December 2020. Overdose visit counts and rates per 100 allcause ED visits during the COVID-19 pandemic were compared with the levels predicted based on 2018 and 2019 visits using graphical analysis and an epidemiologic outbreak detection cumulative sum algorithm.Results: Overdose visit counts increased by 10.5% (n¼3486; 95% confidence interval [CI] 4.18% to 17.0%) in 2020 compared with the counts in 2018 and 2019 (n¼3020 and n¼3285, respectively), despite a 14% decline in all-cause ED visits. Opioid overdose rates increased by 28.5% (95% CI 23.3% to 34.0%) from 0.25 per 100 ED visits in 2018 to 2019 to 0.32 per 100 ED visits in 2020. Although all 6 studied health care systems experienced overdose ED visit rates more than the 95th percentile prediction in 6 or more weeks of 2020 (compared with 2.6 weeks as expected by chance), 2 health care systems experienced sustained outbreaks during the COVID-19 pandemic. Conclusion:Despite decreases in ED visits for other medical emergencies, the numbers and rates of opioid overdose-related ED visits in 6 health care systems increased during 2020, suggesting a widespread increase in opioid-related complications during the COVID-19 pandemic. Expanded community-and hospital-based interventions are needed to support people with opioid use disorder and save lives during the COVID-19 pandemic.

Opioid usage and COVID-19 prognosis: A systematic review and meta-analysis

“…These prognostic factors provide an additional modality of informing the triage process for patients with COVID-19 in the emergency department, especially as the opioid epidemic continues to have considerable independently associated mortality and encompasses a large percentage of all emergency department visits [ [43] , [44] , [45] ].…”

Nonfatal opioid overdoses before and after Covid-19: Regional variation in rates of change

“…To our knowledge, only a few peer-reviewed reports have examined changes in nonfatal overdoses separate from fatal overdoses during Covid-19. These studies, which examined changes in Emergency Department (ED) visits for nonfatal overdoses in a small sample of healthcare systems, found increased rates of such visits (as a proportion of all ED visits) during 2020 compared with previous years [ 16 , 21 , 22 ]. However, counts of such visits increased in only some of the health systems evaluated, and even declined in others [ 22 ].…”

“…These studies, which examined changes in Emergency Department (ED) visits for nonfatal overdoses in a small sample of healthcare systems, found increased rates of such visits (as a proportion of all ED visits) during 2020 compared with previous years [ 16 , 21 , 22 ]. However, counts of such visits increased in only some of the health systems evaluated, and even declined in others [ 22 ]. Recent data released by the CDC also documented variation across US states in suspected nonfatal overdoses from ED visits [ 23 ].…”

The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic

“…A national study using NSSP data, comparing ED visit counts for OOD for March 15-October 10, 2020 to the same period in 2019, found a significantly higher number in 2020 ( Holland et al, 2021 ). Similarly, a study of 25 emergency departments across 6 states compared rates of OOD visits in 2018-2019 to visits during the COVID-19 pandemic and found a 10.5% increase in 2020 despite a 14% decline in all-case ED visits ( Soares et al, 2021 ). Conversely, a study of 108 EDs in 18 U.S. states compared ED visits from March-July 2020 to the same period in 2019 found a decline in rates for OOD which began in mid-March ( Pines et al, 2021 ).…”