Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems - 19/01/22
, Edward R. Melnick, MD, MHS b, Bidisha Nath, MBBS, MPH b, Gail D’Onofrio, MD, MS b, Hyung Paek, MD c, Rachel M. Skains, MD d, Lauren A. Walter, MD d, Martin F. Casey, MD, MPH e, Anthony Napoli, MD, MHL f, Jason A. Hoppe, DO g, Molly M. Jeffery, PhD h
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Abstract |
Study objective |
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 all-cause 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% (n=3486; 95% confidence interval [CI] 4.18% to 17.0%) in 2020 compared with the counts in 2018 and 2019 (n=3020 and n=3285, 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.
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| Please see page 159 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: David L. Schriger, MD, MPH. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: WES, ERM, MMJ, GD, and BN significantly contributed to the conception and design of the study. HP, RMS, MFC, AN, WES, and JAH acquired the data. MMJ, WES, GD, and ERM analyzed the data. WES, ERM, BN, and MMJ drafted the initial manuscript. All authors were involved in data interpretation, revised the manuscript, and approved the final version submitted for publication. WES take responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Supported within the National Institutes of Health (NIH) Health Care Systems Research Collaboratory by the NIH Common Fund through cooperative agreement U24AT009676 from the Office of Strategic Coordination within the Office of the NIH Director and cooperative agreement (UH3DA047003) from the National Institute on Drug Abuse of the National Institutes of Health. WES is supported by grant No. 5K08DA045933-03 from the National Institute on Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. |
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Vol 79 - N° 2
P. 158-167 - février 2022 Retour au numéro
Article précédent
- Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study
- Abraham K.C. Wai, Carlos K.H. Wong, Janet Y.H. Wong, Xi Xiong, Owen C.K. Chu, Man S. Wong, Matthew S.H. Tsui, Timothy H. Rainer
- Moving Upstream: A Social Emergency Medicine Approach to Opioid Use Disorder
- Elizabeth A. Samuels, Kelly M. Doran
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