Study Objectives
Opioid overdose (OD) is a leading cause of accidental death in the US. To combat the epidemic, emergency departments (EDs) have implemented several ED-based programs to immediately treat this high-risk population, including medications for opioid use disorder (MOUD), take-home naloxone kits, and ED-based peer supporters providing linkage to treatment. Early during the COVID-19 pandemic, many nonemergent hospital resources became unavailable. We have previously shown that while ED volumes decreased, the number of patients with OUD was not decreased in the same proportion. However, the effect of the pandemic on availability and utilization of ED-based resources for patients at high risk for opioid OD is poorly understood. The purpose of this study was to determine the effect of the early COVID-19 pandemic on the utilization of ED-based programs and resources for patients with opioid use disorder.
Methods
This was a retrospective IRB approved analysis of patients with high-risk for opioid OD presenting to a large urban Midwestern ED. Patients were considered high-risk for a subsequent opioid OD by using a predefined algorithm using the electronic health record (EHR, Epic systems). ED utilization of MAT, outpatient naloxone kits, access to ED-based peer support, and direct transport to a treatment facility during the early COVID-19 pandemic (COVID, March 1, 2020 to December 30th, 2020) was compared to the previous year (PreCOVID, March 1, 2019 to December 30, 2020). Statistical comparison was by Fisher’s exact test.
Results
There were 363 ED visits during the early COVID timeframe and 544 patients in the PreCOVID timeframe that were considered high risk for subsequent opioid OD. During the COVID timeframe there was an increase in the rate of use of ED-based outpatient suboxone treatment (26% for COVID vs. 12% for PreCOVID, p<0.001), increase in naloxone kits given (23% vs. 15%, p=0.0084), and an increase in patients directly transported to a treatment facility by ED-peer supporters (17% for COVID vs. 9% for PreCOVID). There was an associated decrease in 90-day subsequent OD (2.5% for COVID vs. 5.9% for PreCOVID, p=0.015)
Conclusion
The COVID-19 pandemic did not lead to a decrease in utilization of ED-based programs for the treatment of OUD to prevent subsequent ODs in this health care system. Patients presenting to the ED who were at high risk for an opioid OD able to access and utilized resources at an increased rate, which was associated with a decrease in 90-day opioid OD.
No, authors do not have interests to disclose