Table 5.
Opioid use disorder-related clinical eventsa (2016–2019 and 2020–2021) overall and for subtypes in the nationwide emergency department sample.b
| OUD-related clinical events | Between 2016 and 2019 |
During the COVID-19 pandemic in 2020 and 2021 |
||||
|---|---|---|---|---|---|---|
| 2019 Rate, per 10,000 | Absolute difference from 2016 to 2019c | Percentage change from 2016 to 2019, % | 2021 Rate, per 10,000 | Absolute difference from 2019 to 2021d | Percentage change from 2019 to 2021, % | |
| A. Nonfatal opioid overdose | 23.0 (20.8–25.1) | −1.8 (−5.0 to 1.4) | −7.3 (−20.1 to 5.6) | 28.7 (26.6–30.9) | 5.7 (2.7–8.7) | 24.8 (11.5–38.0) |
| Synthetic opioids as a proxy for fentanyl | 1.9 (1.7–2.1) | 0.5 (0.3–0.8) | 39.6 (21.6–57.6) | 4.3 (3.9–4.8) | 2.4 (1.9–2.9) | 125.4 (99.5–151.3) |
| Prescription natural/semisynthetic opioids as a proxy for opioid pain medications | 6.3 (5.6–6.9) | 0.1 (−0.7 to 0.8) | 1.0 (−10.6 to 12.5) | 8.7 (8.0–9.4) | 2.4 (1.5–3.4) | 39.0 (24.3–53.7) |
| Heroin | 10.7 (9.5–11.8) | −2.1 (−4.3 to 0.2) | −16.1 (−33.5 to 1.2) | 9.8 (8.5–11.1) | −0.8 (−2.6 to 0.9) | −7.8 (−24.1 to 8.5) |
| Opium | 0.1 (0.1–0.1) | −0.1 (−0.1 to −0.06) | −47.1 (−66.3 to −27.8) | 0.1 (0.1–0.2) | 0.02 (−0.02 to 0.06) | 17.9 (−18.9 to 54.8) |
| Methadone | 0.5 (0.5–0.6) | −0.2 (−0.3 to −0.1) | −29.8 (−42.5 to −17.2) | 0.5 (0.5–0.6) | −0.03 (−0.1 to 0.05) | −4.7 (−19.3 to 10.0) |
| Other opioids | 4.0 (3.4–4.7) | 0 (−0.7 to 0.7) | 0 (−17.7 to 17.7) | 6.0 (5.5–6.5) | 2.0 (1.2–2.8) | 50.0 (29.2–70.8) |
| B. Injection drug-use related acute infection | 5.5 (5.0–6.0) | 0.5 (−0.3 to 1.3) | 10.0 (−6.6 to 26.6) | 5.5 (5.0–6.0) | 0 (−0.8 to 0.8) | 0 (−15.1 to 15.1) |
| Phlebitis | 0.1 (0.1–0.1) | −0.01 (−0.04 to 0.01) | −9.7 (−29.4 to 10.1) | 0.1 (0.1–0.1) | −0.03 (−0.05 to −0.01) | −27.7 (−47.9 to −7.5) |
| Abscess and/or cellulitis | 3.7 (3.3–4.0) | 0.1 (−0.4 to 0.6) | 2.9 (−11.8 to 17.6) | 3.4 (3.0–3.8) | −0.3 (−0.8 to 0.2) | −7.4 (−21.4 to 6.7) |
| Infectious endocarditis | 0.4 (0.3–0.4) | 0.07 (0–0.1) | 23.4 (−1.1 to 47.9) | 0.3 (0.3–0.4) | −0.05 (−0.1 to 0.03) | −12.5 (−31.6 to 6.6) |
| Infectious arthritis | 0.2 (0.1–0.2) | 0.05 (0.02–0.08) | 46.7 (15.4–78.1) | 0.2 (0.1–0.2) | 0 (−0.03 to 0.04) | 1.9 (−20.2 to 24.0) |
| Sepsis or bacteremia | 2.4 (2.2–2.7) | 0.7 (0.4–1.0) | 41.2 (24.9–57.5) | 2.7 (2.5–3.0) | 0.3 (0.02–0.6) | 12.5 (1.0–24.0) |
| C. Substance abuse treatment | 3.4 (2.2–4.5) | −0.7 (−2.4 to 1.0) | −17.1 (−57.6 to 23.5) | 3.6 (2.5–4.8) | 0.2 (−1.5 to 1.9) | 5.9 (−43.0 to 54.8) |
| Detoxification services | 2.9 (1.9–4.0) | −1.0 (−2.5 to 0.5) | −25.6 (−64.9 to 13.6) | 3.1 (2.1–4.1) | 0.2 (−1.2 to 1.6) | 6.9 (−40.9 to 54.7) |
| Individual counseling | 0.1 (−0.1 to 0.4) | −0.1 (−0.4 to 0.3) | −31.8 (−183 to 119.4) | 0.3 (0.01–0.6) | 0.1 (−0.2 to 0.5) | 86.7 (−154.3 to 327.6) |
| Group counseling | 0.3 (−0.1 to 0.6) | −0.04 (−0.6 to 0.5) | −12.5 (−186.6 to 161.6) | 0.4 (0.03–0.8) | 0.1 (−0.4 to 0.7) | 50.0 (−138.4 to 238.4) |
| Individual psychotherapy | 0.2 (−0.2 to 0.6) | 0.2 (−0.2 to 0.6) | 320.0 (−472.8 to 1112.8) | 0.06 (−0.01 to 0.1) | −0.2 (−0.5 to 0.2) | −71.4 (−260.2 to 117.3) |
| Family counseling | NRe | NRe | NRe | NRe | NRe | NRe |
| Medication management | 0.7 (0.02–1.3) | 0.5 (−0.2 to 1.1) | 242.1 (−98.2 to 582.4) | 0.2 (0.06–0.3) | −0.5 (−1.1 to 0.1) | −75.4 (−173.0 to 22.3) |
| Pharmacotherapy | 0.5 (−0.1 to 1.1) | 0.4 (−0.3 to 1.0) | 233.3 (−189.9 to 656.5) | 0.4 (−0.02 to 0.8) | −0.1 (−0.9 to 0.6) | −26.0 (−173.9 to 121.9) |
Cases of Opioid Use Disorder-related clinical events represented as nonfatal opioid overdose, injection drug use-related acute infection, and substance abuse treatment.
Weights provided by the Healthcare Cost and Utilization Project, Nationwide Emergency Department Sample was used to ensure that the estimates were nationally representative, and weights and design variables were included to obtain unbiased estimates and standard errors.
Reflects the overall or total difference between 2016 and 2019: absolute difference (2019–2016) and percentage change [(2019–2016)/2016 × 100].
Reflects the overall or total difference during the COVID-19 pandemic in 2020 and 2021: absolute difference (2021–2019) and percentage change [(2021–2019)/2019 × 100].
NR, Not Reportable. Suppressed to protect confidentiality, ≤10 cases.