How emergency department visits for substance use disorders have evolved during the early COVID-19 pandemic

Pines, Jesse M.; Zocchi, Mark S.; Black, Bernard S.; Carlson, Jestin N.; Celedon, Pablo; Moghtaderi, Ali; Venkat, Arvind

doi:10.1016/j.jsat.2021.108391

Cited by 25 publications

(34 citation statements)

References 16 publications

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“…We defined SUD conditions based on ED diagnosis of International Classification of Disease , Tenth Revision , Clinical Modification (ICD-10-CM) diagnosis codes. Consistent with prior work, we defined SUD using diagnosis code groupings of the Clinical Classification Software Revised (CCSR) system, maintained by the Healthcare Cost and Utilization Project [ 9 , 18 ] to provide useful groupings of diagnosis codes, as well as select subsets of public health interest within that group including opioid overdose and opioid use disorder (OUD) (MBD018) and alcohol use disorders (AUD) (MBD017) [ 19 ], as well as other SUD inclusive of cannabis (MBD019), sedative/hypnotic/anxiolytic (MBD020), cocaine/other stimulant (MBD021), hallucinogenic (MBD022), inhalant (MBD023), and other psychoactive substance-related disorders (MBD025). As reference and to characterize changes in ED visitation for SUDs, we also characterized ED visit counts for two common acute medical emergencies, acute myocardial infarction and stroke (CCSR codes CIR009 and CIR020 ).…”

Section: Methodsmentioning

confidence: 99%

“…More recently, the CDC has provisionally released that 96,779 drug overdose deaths have occurred in the twelve months preceding the end of March 2021, a new record for the highest number of drug overdose deaths in a twelve-month period ever recorded. Despite this, work characterizing changes in ED visits for SUD have documented decreased visit rates through July in a large contract management group sample of 108 EDs across 18 states, with a more muted decline in arrivals by EMS for opioid related reasons [ 9 ]. Other work using administrative claims data found similar declines in ED visits for substance use disorders through April 20, 2020 [ 10 ], and work using the National Syndromic Surveillance Program data found that ED visits were above the 2019 baseline for mental health, suicide attempts, overdose, and violence through October, 2020 [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Most of the studies that conducted comparison between pre-and post-pandemic periods (n=20) showed that overdose death has been increased (n=15 28,29,34,40,65,66,[72][73][74][75][76][77][78][79][80][81] , 7 with significant findings 28,29,65,66,72,73,78 ) compared to pre-pandemic figures. Only a few studies found null (n=3) [82][83][84] or a decrease in overdose death (n=2) 49,85 .…”

Section: Overdose Deathsmentioning

confidence: 99%

“…Five studies investigated the type of substance overdosed 72,73,79,81,82 or examined a specific drug e.g. methadone (a prescription opioid) 78,83 or alcoholic drinks 78 .…”

Section: Overdose Deathsmentioning

confidence: 99%

Have deaths of despair risen during the COVID-19 pandemic? A rapid systematic review

Rahimi-Ardabili

Feng

Nguyen

et al. 2022

Preprint

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Objective: To systematically review the literature on the impact of the COVID-19 pandemic on deaths of despair (suicide, overdoses and drug-related liver diseases). Methods: Five electronic databases were searched using search terms on deaths of despair and COVID-19. Results: The review of 70 publications included indicates that there is no change or a decline in the suicide rate during the pandemic compared to the pre-pandemic period. Drug-related deaths such as overdose deaths and liver diseases, however, have been increased compared to the pre-pandemic rate. Findings are mainly from middle-high- and high-income countries and data from low-income countries are lacking. Synthesis of data from subgroup analysis indicates that some groups such as Black people, women and younger age groups would be more vulnerable to socioeconomic disruption during the pandemic. Conclusion: Studies included in this review were preliminary and suffered from methodological limitations such as lack of inferential analysis or using provisional data. Further high-quality studies are needed considering the contribution of factors such as disease prevalence, government intervention and environmental characteristics.

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“…Those with OUD are more vulnerable to the social and economic stressors related to COVID-19, including social distancing, quarantine, fear of illness, and unemployment (Becker et al, 2020; Khatri and Perrone, 2022; Alexander et al, 2020 ). As a result, increased opioid use, risk of relapse for those in recovery, along with a rise in non-fatal/fatal overdoses have been observed ( Khoury et al, 2021 ; Pines et al, 2021 ; Slavova et al, 2020 ; Rogers et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care

Vallecillo

Fonseca

et al. 2022

Drug and Alcohol Dependence Reports

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Introduction : During the COVID-19 pandemic, limited access to health care augmented COVID-19 risk in subjects with opioid use disorder (OUD). The aim of the study was to compare COVID-19 incidence in individuals with OUD receiving continuous clinical care with that of the general population. Methods : A prospective cohort study was carried out from March 2020 to March 2021 comparing COVID-19 cumulative incidence of individuals presenting an OUD receiving integrated clinical care with that of an age-reference general population, in three public outpatient treatment centers for addiction in Barcelona, Spain. Results : Over the study period, 366 individuals received clinical care. Mean age: 48.2±8.9 years, 280 (76.5%) were men and 283 (77.3%) native Spanish. All subjects were on opioid agonist therapy. Prevalence of communicable diseases were: HIV infection in 109 (29.8%) and hepatitis C in 46 (12.6%). Psychiatric comorbidity was present in 207 (56.6%), and 119 (32.5%) had >1 chronic medical disease. COVID-19 was diagnosed in 10 patients : a cumulative incidence of 2,732 casesx100,000 people/year (C.I.95%: 1,318–4,967). There were no differences compared to the age-general population: 2,856 casesx100,000 people/year (C.I.95%: 2,830–2,880) (p=0.81). In the bivariate analysis, hypertension (5[50.0%] vs. 53[14.9%], p=0.01) and cardiovascular chronic diseases (2 [20.0%] vs. 8 [2.2%], p=0.03) were more prevalent in patients with OUD and COVID-19. Conclusions : Individuals with OUD who received integrated clinical care had a COVID-19 incidence comparable to the general population. Ensuring comprehensive healthcare is essential to prevent the clinical impact of COVID-19 on individuals with OUD.

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How emergency department visits for substance use disorders have evolved during the early COVID-19 pandemic

Cited by 25 publications

References 16 publications

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

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

Have deaths of despair risen during the COVID-19 pandemic? A rapid systematic review

Similar COVID-19 incidence to the general population in people with opioid use disorder receiving integrated outpatient clinical care

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