<i>Notes from the Field: </i>Opioid Overdose Deaths Before, During, and After an 11-Week COVID-19 Stay-at-Home Order — Cook County, Illinois, January 1, 2018–October 6, 2020

Mason, Maryann; Welch, Sarah B; Arunkumar, Ponni; Post, Lori A.; Feinglass, Joseph

doi:10.15585/mmwr.mm7010a3

Cited by 55 publications

(52 citation statements)

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“…This finding is consistent with other published literature. 3 , 27 , 28 , 29 , 30 , 31 , 32 , 33 Our results suggest drug use is the main factor in accidental toxicity associated with death rather than use of alcohol. Potential reasons for this increase in drug-related deaths may include barriers to accessing harm reduction services and treatment, generally increased stressors during the pandemic with overall negative impacts on mental health driving increased drug use, and physical distancing mandates (possibly leading to more individuals using drugs alone).…”

Section: Discussionmentioning

confidence: 76%

Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

Dmetrichuk

Rosenthal

Man³

et al. 2022

The Lancet Regional Health - Americas

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Background The effects of the COVID-19 pandemic on non-natural manners of death in Ontario is not known. Understanding the indirect consequences of the pandemic and related public health measures (i.e. lockdown) fills a vital need to inform best practice in public health and guide policy decisions. Methods The Office of the Chief Coroner and the Ontario Forensic Pathology Service (OCC-OFPS) investigate sudden and unexpected deaths in the province of Ontario. The number of homicides, suicides, and accidental deaths (non-natural deaths=77,655) were extracted from the centralized Coroner's Information System database (total deaths=197,966), across four provincially defined stages of lockdown related to the COVID-19 pandemic (March 17 to December 31, 2020), and crude rates (per 100,000 people) were compared to the previous eleven years. Findings There was no major change to the rate of homicides during 2020 compared to 2009-2019 (RR 1⋅1, 95% CI 0⋅95-1⋅2; p=0⋅19; estimated annual effect=21 more deaths in 2020). The rate of suicides also did not show an overall major change in 2020 (RR 1⋅02, 95% CI 0⋅96-1⋅1; p=0⋅50; estimated annual effect=27 more deaths in 2020). However, during the first stage of lockdown (Stage 0), there was a decrease in the rate of suicides compared to all combinations of recent years from 2013 onwards (RRs 0⋅82-0⋅86, combined 95% CI 0⋅69-0⋅99; max p=0⋅039; estimated effect of 30 less deaths in Stage 0). There was an excess of over 1,500 accidental drug-related deaths that occurred during 2020 (RR 2⋅5, 95% CI 2⋅4-2⋅7; p<0⋅001). This finding held up to ‘interrupted time series’ robustness testing, indicating that 2020 had substantially more drug-related deaths, even when accounting for the linear increasing trend over time. Although motor vehicle collision associated fatalities appeared to decrease slightly in 2020 (RR 0⋅89, 95% CI 0⋅81-0⋅96; p=0⋅0039; estimated annual effect of 78 less deaths), we could not conclude any lockdown-associated effect, particularly when compared to 2019 (RR 0⋅26, 95% CI 0⋅75-1⋅1; p=0⋅26). Interpretation In Ontario, the short-term effects of the COVID-19 pandemic did not greatly increase homicide or suicide rates, nor decrease motor vehicle collision fatality rates; however, the longer-term impact of the pandemic remains to be elucidated and ongoing vigilance is warranted in the event that other trends emerge. Accidental drug-related fatalities substantially increased during all stages of the lockdown, marking an urgent need for consideration in policy. These results highlight the vital role of death investigation systems in providing high quality and timely data to inform public health recommendations.

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Section: Discussionmentioning

confidence: 76%

Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

Dmetrichuk

Rosenthal

Man³

et al. 2022

The Lancet Regional Health - Americas

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“…Our findings parallel reported U.S. trends showing increased rates of opioid overdose during the pandemic. 30 Increased opioid use in our cohort of FGIMD may suggest exacerbation of chronic pain associated with their functional GI disorder and increased prescription possibly from non‐specialist clinicians who may not be aware of diagnoses of FGIMD. Another explanation is that patients with FGIMD who have concurrent opioid use disorders may have experienced substance abuse relapse due to disruptions in healthcare and lack of prior support by providers.…”

Section: Discussionmentioning

confidence: 86%

Gastrointestinal symptoms and healthcare utilization have increased among patients with functional gastrointestinal and motility disorders during the COVID‐19 pandemic

Gubatan

Zikos

Bishop

et al. 2021

Neurogastroenterology Motil

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Background The coronavirus disease 2019 (COVID‐19) pandemic has led to unprecedented disruptions in healthcare. Functional gastrointestinal and motility disorders (FGIMD) are associated with significant healthcare utilization. The clinical implications of these healthcare disruptions due to the COVID‐19 pandemic on clinical outcomes in patients with FGIMD are unclear. Methods We performed a retrospective study of patients with three common FGIMD (irritable bowel syndrome [IBS], gastroparesis, functional dyspepsia [FD]) tested for SARS‐CoV‐2 to describe alterations in gastrointestinal symptoms, medication use, and healthcare utilization during and before the pandemic and factors associated with COVID‐19. Key Results The prevalence of COVID‐19 during the pandemic (03/2020–09/2020) was 3.20% (83/2592) among patients with FGIMD, 3.62% in IBS (57/1574), 3.07% in gastroparesis (23/749), and 2.44% in FD (29/1187) at our institution. Patients with FGIMD had increased abdominal pain, nausea/vomiting, diarrhea, constipation, and weight loss ( p < 0.001) along with increased proton pump inhibitor, H2 blocker, and opioid use ( p < 0.0001). Both inpatient hospitalizations and outpatient visits ( p < 0.0001) and number of diagnostic tests including cross‐sectional imaging ( p = 0.002), and upper and lower endoscopies ( p < 0.0001) were significantly higher during the pandemic as compared to 6 months prior. Diarrhea‐predominant IBS was positively (OR 2.37, 95% CI 1.34–4.19, p = 0.003) associated with COVID‐19, whereas functional dyspepsia was negatively (OR 0.46, 95% CI 0.27–0.79, p = 0.004) associated. Conclusions & Inferences Patients with common functional gastrointestinal and motility disorders have reported more gastrointestinal symptoms during the COVID‐19 pandemic with concurrent increased medication use and healthcare utilization.

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“…SIP policies might lead to unemployment or reduced economic activity (S. . SIP policies may increase stress and anxiety due to social isolation (Xie et al 2020;Patrick et al 2020), potentially leading to increased substance use and suicides (Mason et al 2021;Holland et al 2021). Reduced physical mobility may have also caused increases in child abuse and domestic violence (Leslie and Wilson 2020;Cappa and Jijon 2021), which can adversely affect health in both the short and long run (Sonu, Post, and Feinglass 2019).…”

Section: Introductionmentioning

confidence: 99%

The Impact of the COVID-19 Pandemic and Policy Responses on Excess Mortality

Agrawal¹,

Cantor²,

Sood³

et al. 2021

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As a way of slowing COVID-19 transmission, many countries and U.S. states implemented shelter-in-place (SIP) policies. However, the effects of SIP policies on public health are a priori ambiguous as they might have unintended adverse effects on health. The effect of SIP policies on COVID-19 transmission and physical mobility is mixed. To understand the net effects of SIP policies, we measure the change in excess deaths following the implementation of SIP policies in 43 countries and all U.S. states. We use an event study framework to quantify changes in the number of excess deaths after the implementation of a SIP policy. We find that following the implementation of SIP policies, excess mortality increases. The increase in excess mortality is statistically significant in the immediate weeks following SIP implementation for the international comparison only and occurs despite the fact that there was a decline in the number of excess deaths prior to the implementation of the policy. At the U.S. state-level, excess mortality increases in the immediate weeks following SIP introduction and then trends below zero following 20 weeks of SIP implementation. We failed to find that countries or U.S. states that implemented SIP policies earlier, and in which SIP policies had longer to operate, had lower excess deaths than countries/U.S. states that were slower to implement SIP policies. We also failed to observe differences in excess death trends before and after the implementation of SIP policies based on pre-SIP COVID-19 death rates.

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Notes from the Field: Opioid Overdose Deaths Before, During, and After an 11-Week COVID-19 Stay-at-Home Order — Cook County, Illinois, January 1, 2018–October 6, 2020

Cited by 55 publications

References 1 publication

Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

Retrospective study of non-natural manners of death in Ontario: Effects of the COVID-19 pandemic and related public health measures

Gastrointestinal symptoms and healthcare utilization have increased among patients with functional gastrointestinal and motility disorders during the COVID‐19 pandemic

The Impact of the COVID-19 Pandemic and Policy Responses on Excess Mortality

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