Emergency department utilization for substance use disorders and mental health conditions during COVID-19

Abstract

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

The COVID‐19 impact and characterization on substance use‐related emergency department visits for adolescents and young adults in Canada: Practical implications

“…28,30 Many substance use patients rely on the emergency department (ED) as a de facto safety net. 33 ED visits and their frequency are also an index of severe psychopathology because many substance users who access the ED present with intoxication and overdose, possibly reflecting pandemic-related community distress and healthcare disruption. 11 Since the prepandemic era, EDs have become the fastest-growing source of assistance for mental health and addiction challenges in the United States and Canada.…”

“…[34][35][36][37][38] With a backlog of substance use patients, waves of substance use-related ED visits may be expected. 33 Thus far, the trend in terms of the volume of substance-related ED visits during the pandemic has been frequently reported, mostly suggesting a decline, 11,28,33,[39][40][41][42] with an exception that reports an increase of ED visits for alcohol intoxication when measured a few weeks before and after the lockdown in Italy. 43 However, as COVID-19 continues to evolve, updating the trend of substance use-related ED visits is essential to reach a global consensus.…”

Profiles of quality of outpatient care use, associated sociodemographic and clinical characteristics, and adverse outcomes among patients with substance-related disorders

“…A 2014-18 US study reported that 9.4% of annual emergency department (ED) use and 11.9% of hospitalizations were related to substance use disorders [3]. ED use by patients with SRD may be related to intoxication, overdose, withdrawal, or associated health conditions [4]. Frequent ED use and hospitalizations are costly, and are key indicators of adverse outcomes [5], often indicating lack of appropriate outpatient care as well [6].…”

Characterizing people with frequent emergency department visits and substance use: a retrospective cohort study of linked administrative data in Ontario, Alberta, and B.C., Canada

“…In North America, substance use accounts for one in 11 ED visits[ 5 ], and its healthcare burden is increasing over time [ 6 , 7 ]. In particular, proportions of ED visits related to substance use disorders have increased since onset of COVID-19 [ 8 , 9 ], indicating a growing need to recognize high risk substance use patterns in the ED to mitigate future harms.…”