Racial/Ethnic Disparities in Unintentional Fatal and Nonfatal Emergency Medical Services–Attended Opioid Overdoses During the COVID-19 Pandemic in Philadelphia

Khatri, Utsha G.; Pizzicato, Lia N.; Viner, Kendra; Bobyock, Emily; Sun, Monica; Meisel, Zachary F.; South, Eugenia C.

doi:10.1001/jamanetworkopen.2020.34878

Cited by 107 publications

(84 citation statements)

References 5 publications

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“… Patient experiences ( n = 1) Krawczyk et al [ 26 ] (International) Qualitative 300 posts of Reddit users related to COVID-19 and opioid used Concerns over less in-person access to OUD treatment facilities, COVID-19 testing treatment requirements and exposure to COVID were reported as an influence on motivation to seek treatment. Patient outcomes ( n = 5, 33%) Overdose (n = 3) Khatri et al [ 27 ] (U.S./Pennsylvania) Retrospective Philadelphia Dep Health Substance Use Dashboard and Medical Examiner’s Office Data African Americans comprised 80% of overdose ED visits post-pandemic, compared to 63% pre-pandemic. Ochalek et al [ 28 ] (U.S./Virginia) Retrospective Electronic medical record of Virginia Commonwealth University During the pandemic, 2.5 patients were seen per day in the emergency department with opioid overdose, compared to 1.4 patients per day pre-pandemic.…”

Section: Resultsmentioning

confidence: 99%

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Alexander

Pogorzelska-Maziarz

Gerolamo

et al. 2021

Subst Abuse Treat Prev Policy

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Research objective The COVID-19 pandemic disrupted healthcare delivery worldwide with likely negative effects on people who use opioids (PWUO). This scoping review of the original research literature describes the impact of the COVID-19 pandemic on healthcare delivery for PWUO and identifies gaps in the literature. Methods This scoping review of the original research literature maps the available knowledge regarding the impact of the COVID-19 pandemic on healthcare delivery for PWUO. We utilized the methodology developed by the Joanna Briggs Institute for scoping reviews, and content analyses methodology to characterize the current state of the literature. Results Of the 14 included studies, administrative database (n = 11), cross-sectional (n = 1) or qualitative (n = 2) studies demonstrated service gaps (n = 7), patient/provider experiences (n = 3), and patient outcomes for PWUO (n = 4). In March 2020, healthcare utilization dropped quickly, sharply increasing only for reasons of opioid overdose by May 2020. Service gaps existed in accessing treatment for new patients during the pandemic due to capacity and infrastructure limits. Physicians reported difficulty referring patients to begin an outpatient opioid treatment program due to increased restrictions in capacity and infrastructure. Patients also reported uncertainty about accessing outpatient treatment, but that telehealth initiation of buprenorphine increased access to treatment from home. Disproportionate increases in overdose rates among African Americans were reported in two studies, with differences by race and gender not examined in most studies. Fatal overdoses increased 60% in African Americans during the pandemic, while fatal overdoses in Non-Hispanic White individuals decreased. Conclusions In summary, this beginning evidence demonstrates that despite early reluctance to use the healthcare system, opioid overdose-related use of healthcare increased throughout the pandemic. Service delivery for medications to treat OUD remained at or above pre-pandemic levels, indicating the ability of telehealth to meet demand. Yet, racial disparities that existed pre-pandemic for PWUO are intensifying, and targeted intervention for high-risk groups is warranted to prevent further mortality. As the pandemic progresses, future research must focus on identifying and supporting subgroups of PWUO who are at heightened risk for experiencing negative outcomes and lack of access to care.

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Section: Resultsmentioning

confidence: 99%

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Alexander

Pogorzelska-Maziarz

Gerolamo

et al. 2021

Subst Abuse Treat Prev Policy

View full text Add to dashboard Cite

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“…Third, our sample had low racial and ethnic diversity. Because Black, Indigenous, and People of Color disproportionately suffered from death and other complications of SARS-COV-2 [51] and also disproportionately experience opioid-related harms, including during the pandemic [52], future work should explore intersecting vulnerabilities of SUD, hospitalization, and acute crises like pandemics in this population. Fourth, it is possible that our research does not encompass all challenges faced by marginalized patients in healthcare systems.…”

Section: Discussionmentioning

confidence: 99%

Understanding the impact of the SARS-COV-2 pandemic on hospitalized patients with substance use disorder

et al. 2021

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Background The SARS-COV-2 pandemic rapidly shifted dynamics around hospitalization for many communities. This study aimed to evaluate how the pandemic altered the experience of healthcare, acute illness, and care transitions among hospitalized patients with substance use disorder (SUD). Methods We performed a qualitative study at an academic medical center in Portland, Oregon, in Spring 2020. We conducted semi-structured interviews, and conducted a thematic analysis, using an inductive approach, at a semantic level. Results We enrolled 27 participants, and identified four main themes: 1) shuttered community resources threatened patients’ basic survival adaptations; 2) changes in outpatient care increased reliance on hospitals as safety nets; 3) hospital policy changes made staying in the hospital harder than usual; and, 4) care transitions out of the hospital were highly uncertain. Discussion Hospitalized adults with SUD were further marginalized during the SARS-COV-2 pandemic. Systems must address the needs of marginalized patients in future disruptive events.

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“…Published research in the past year discussed the rising prevalence of substance use around the world [ 3 ▪ , 4 ▪ , 6 ▪ , 7 ▪▪ , 8 ▪ ] and suggested that individuals who use substances may be at an increased risk for COVID-19 [ 32 ▪ , 33 ▪▪ ]. Implementation of stay-at-home orders were associated with increased overdose rates [ 19 ▪ – 21 ▪ ]. In addition to differences in substance use and overdose rates, systematic and individual barriers to care increased because of pandemic mitigation efforts [ 11 ▪ ] including closures/reductions in treatment or management services [ 12 ▪ , 27 ▪ ] and difficulty finding out about/unfamiliarity with available resources [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Opioid overdose-related runs by emergency medical services also rose in Kentucky after the SAHO was implemented [ 20 ▪ ]. The SAHO in Philadelphia was associated with an increase in the mean number of unintentional fatal opioid overdoses per month for non-Hispanic Black people [ 21 ▪ ]. In New Zealand, a significant increase was observed in the percentage of patients arriving to one emergency department with an overdose in the mandated lockdown compared with before the lockdown [ 22 ▪▪ ].…”

Section: Overdose Riskmentioning

confidence: 99%

Converging public health crises: substance use during the coronavirus disease 2019 pandemic

Striley

Hoeflich

2021

Current Opinion in Psychiatry

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Purpose of review The international, public health crisis caused by the rapid spread of SARS-CoV-2 has resulted in unforeseen medical and psychiatric consequences. We reviewed publications from January 2020 to January 2021, given that earlier documents were not relevant, to review findings on changes in substance use and overdoses during the pandemic. Additionally, this review of the literature also documents advocacy efforts, health service modification and challenges, as well as COVID-related health complications associated with substance use. Recent findings Recent work focused on identifying changes in the distribution and use of substances as well as the unique challenges to promoting the health of persons who use substances in the current pandemic. Although COVID-19 has triggered unprecedented innovations in the organizational and public policy, the use of certain substances (alcohol, cannabis, cigarettes, fentanyl, heroin, and opiates) is increasing internationally. Unique associations between substance use and pandemic-related adverse health outcomes were identified. In addition, the pandemic precipitated significant barriers and disruptions to care. Summary Given increased overdose rates and infections among people who use drugs, continued surveillance and vigilance are needed to assess changes and reduce use and adverse consequences during the continuing COVID-19 crisis. Changes are urgently needed to reduce adverse health outcomes because of treatment barriers and lack of adequate treatment options. Additionally, integrative approaches are necessary to promote the public health of persons who use substances.

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Racial/Ethnic Disparities in Unintentional Fatal and Nonfatal Emergency Medical Services–Attended Opioid Overdoses During the COVID-19 Pandemic in Philadelphia

Abstract: Non-Hispanic White individuals Non-Hispanic Black individuals Hispanic individuals a Period C indicates period of stay-at-home order, which began on March 23, 2020.

Cited by 107 publications

References 5 publications

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

The impact of COVID-19 on healthcare delivery for people who use opioids: a scoping review

Understanding the impact of the SARS-COV-2 pandemic on hospitalized patients with substance use disorder

Converging public health crises: substance use during the coronavirus disease 2019 pandemic

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