Study Objectives
As of April 2022, the United States has reached 100,000 drug related deaths in the year preceding. During the COVID-19 pandemic, the national trend of overall emergency department (ED) visits have decreased, while the number of opioid overdoses have increased. However, it is unclear which patient populations are suffering the most from the compounded effect of the opioid overdose epidemic and the COVID-19 pandemic. The goal of this project was to quantify the number of visits to the Loyola University Medical Center (LUMC) ED for opioid overdose during the COVID-19 pandemic compared to a historical control.
Study Designs/Methods
This was a single-center, retrospective cohort of ED visits between March 2019-February 2020 (pre- pandemic) and March 2020-February 2021 (pandemic). Patients were identified using International Classification of Diseases-10 codes consistent with opioid overdose. Patients were excluded for the following reasons: missing or incomplete data, outside hospital transfer, or left before being seen by a physician. The primary endpoint was the proportion of patients presenting to the ED with a chief complaint of opioid overdose. Secondary endpoints included co-ingestion of other substances including alcohol, cocaine, and benzodiazepines, disposition, and median number of ED visits related to intoxication per patient.
Results
Overall, 588 patient charts were reviewed, of which 420 were included. The most common reason for exclusion was opioid intoxication without definitive evidence of overdose, such as naloxone administration or physical exam findings. The pandemic group had 230 overdoses compared to 190 in the pre-pandemic group. Baseline demographics were similar between groups, though significantly more pandemic group patients were male (85.7% vs 78.4%, p=0.05) and Hispanic/Latino (13.5% vs 6.8%, p=0.03). The total number of LUMC ED visits decreased by 17.5% with 38,653 pandemic visits down from 46,877 pre-pandemic visits. Overdoses accounted for 0.60% of pandemic ED visits compared to 0.41% of pre-pandemic ED visits (p<0.0001). Pandemic overdoses had higher rates of co- ingestion with benzodiazepines (14.4% vs 3.2% p<0.001), cocaine (17.4% vs 9.5% p=0.02), and alcohol (15.7% vs 14.2% p=0.68). There was no significant difference in discharge, admit, or transfer rates between the groups (p=0.10). There was a non-significant increase in the median number of ED visits per patient related to intoxication during the pandemic (2 vs 1, p=0.34).
Conclusion
During the pandemic, there was a significant increase in the proportion of ED visits for opioid overdose and overdoses with co-ingestion of benzodiazepines and cocaine. Men and Hispanic/Latinx patients were disproportionately affected. This observed increase in proportion of care in the pandemic for opioid overdose suggests that opioid use is increasing, emphasizing the need for additional harm reduction, addiction medicine and psychosocial services.
No, authors do not have interests to disclose