Surge in Opioid Overdoses Linked to COVID-19

Megan Brooks

September 21, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic has led to an surge in opioid overdose deaths, a new study confirms.

The number of nonfatal opioid-related overdose visits to the Virginia Commonwealth University (VCU) Medical Center emergency department (ED) surged from 102 between March and June 2019 (pre-pandemic) to 227 between March and June 2020, the first four months of the pandemic — an increase of 123%.  

In contrast, compared with the spring of 2019, the total number of heart attack diagnoses decreased from 41 to 31 (-24%) and the number of all ED visits fell from 36,565 to 26,061 (-29%) in the spring of 2020, report the authors, led by Taylor Ochalek, PhD, with the VCU Department of Pharmacology and Toxicology in Richmond.

Compared with 2019, in the early pandemic period, patients diagnosed with opioid-related overdose were more likely to be Black (63% vs 80%), with no marked difference in the mean age of opioid overdose cases (42 years and 44 years, respectively). In both periods, about 30% of overdose cases were women and about 70% male.

In both periods, only a little more than half of overdose patients seen in the ED received a prescription for naloxone. More overdose patients in the pandemic period received treatment resources and/or a referral at discharge (68% vs 44%).

However, only a minority of patients in both periods who were admitted to the hospital or to a 24-hour observation unit received an addiction medicine consult or sought opioid treatment at an affiliated outpatient clinic.

The findings were published online September 18 in Journal of the American Medical Association

Critical Care Gaps

The authors of a linked editorial caution that it's hard to generalize these findings given the limited small sample size and reporting of a single ED. Patients with overdose may have gone to different emergency departments because of closures or ambulance diversion during the pandemic.

On the other hand, the results are "consistent with the hypothesis that the US COVID-19 epidemic has been accompanied by an increase in substance use with important consequences (nonfatal overdose), with a signal of greater effect among people who are Black," write Danielle Haley, PhD, MPH, and Richard Saitz, MD, MPH, Department for Community Health Sciences, Boston University School of Public Health.

This study also highlights the failure to deliver effective treatment for opioid use disorder, "even among patients with a symptomatic life-threatening episode requiring emergency treatment, and even in tertiary care institutions that offer substantial addiction specialty treatment services," Haley and Saitz say.

The finding that only about half of overdose patients received a prescription for naloxone indicates a "critical gap in care that could be addressed in part by mandating naloxone prescriptions for appropriate patients," they write.

Successfully linking and retaining individuals with opioid use disorder to care and treatment will require several comprehensive approaches, Haley and Saitz say.

These include "expanding access, such as eliminating caps on the number of patients who can be treated by a prescriber; expanding community outreach, social services, and telemedicine; [having] more emergency department physicians obtain waivers to initiate medication treatment for patients with opioid use disorder who are discharged from the emergency department; and eliminating the barrier of requiring a waiver to prescribe buprenorphine in the first place."

The study was supported by the National Institutes of Health, Indivior PLC, which develops medicines to treat addition and serious mental illness, and by Virginia Catalyst. One author reported consulting for Indivior PLC, Boehringer Ingelheim, and Astellas and receiving grant support from Indivior PLC and Nektar. Hailey and Saitz have disclosed no relevant financial relationships.

JAMA. Published September 18, 2020. Research Letter, Editorial

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