US Overdose Deaths Spiked During Pandemic, Biggest Rise in Black and Latinx Communities

By Linda Carroll

May 28, 2021

(Reuters Health) - U.S. overdose deaths increased by 42% overall in 2020 compared with 2018 and 2019, a new study of Emergency Medical Services records suggests.

The analysis of data gathered from the National EMS Information System (NEMSIS) found a spike in overdose-related cardiac arrests during the pandemic with the greatest increases seen among Latinx (49.7%) and African American (50.3%) individuals, researchers report in JAMA Psychiatry.

"Some people think of this as a white problem," said the study's lead author, Joseph Friedman, an MD-PhD student at the University of California, Los Angeles. "The profile of those who are dying from overdoses has been shifting rapidly over the past five years and now, I think it's really important to understand that it's a problem that is really affecting the Black and Latinx communities especially. The pandemic has just exacerbated that trend."

To get a better sense of trends in overdose deaths across the nation, Friedman and his team turned to NEMSIS, which provides data in "almost real time," he said. "The Centers for Disease Control and Prevention just released 12 months of data through October of 2020," Friedman noted. "They don't include anything about race and ethnicity and there aren't even any monthly numbers."

In contrast, Friedman said, the NEMSIS data "is broken down by race, ethnicity, income and the kinds of socioeconomic characteristics we think are important. We were able to show that over the past two years, when CDC eventually released their data for the same time period, that the two data sets line up really well."

NEMSIS data come from 11,000 EMS agencies in 49 states, which represented 87% of EMS activations nationally in 2020, the study team notes.

Among the 33.4 million EMS activations in NEMSIS in 2020, 16.8 million (50.2%) involved female patients and 16.3 million (48.8%) involved non-Hispanic White individuals. Of the total, 19,957 were overdose-associated cardiac arrests, which the authors used as a proxy for fatalities.

Overdose-associated cardiac arrest rates were 42.1% higher nationally in 2020 (42.3 per 100,000 EMS activations at baseline versus 60.1 per 100,000 EMS activations in 2020). The largest proportionate increases were among Latinx individuals (a rise of 49.7% with 38.8 per 100,000 activations at baseline versus 58.1 per 100 000 activations in 2020) and African American individuals (a rise of 50.3% with 21.5 per 10,0000 activations at baseline versus 32.3 per 100,000 activations in 2020).

The researchers also saw an increase of 46.4% among people living in more impoverished neighborhoods (42.0 per 100,000 activations at baseline versus 61.5 per 100,000 activations in 2020), and a 63.8% increase in the Pacific states (33.1 per 100,000 activations at baseline versus 54.2 per 100,000 activations in 2020).

The researchers also saw an increase of 46.4% among people living in more impoverished neighborhoods (42.0 per 100,000 activations at baseline versus 61.5 per 100,000 activations in 2020), and a 63.8% increase in the Pacific states (33.1 per 100,000 activations at baseline versus 54.2 per 100,000 activations in 2020).

The researchers estimate that if the historical relationship between EMS-observed overdose-associated cardiac arrests and total overdose mortality rates from CDC data holds true, an expected total of approximately 90,632 overdose deaths may eventually be reported by the CDC for 2020.

"There are a number of important points packed in the study," said Dr. Michael Lynch, medical director of the Pittsburgh Poison Center, medical director of the UPMC Health Plan Substance Use Disorders Services, and an assistant professor in the division of medical toxicology at the University of Pittsburgh School of Medicine.

The pandemic may explain many of them, Dr. Lynch added.

"People, especially earlier in the pandemic, were reticent to seek medical care for almost anything and those using were more likely to be using in isolation, staying at home to avoid contact so they were less likely to be discovered. Even if they were with others, they may have been less likely to call EMS out of fear," Dr. Lynch said. "What's not discussed here, but other data has suggested that even when EMS is called, people are less likely to go to the hospital."

"Another thing the study shows is that the largest increases were in the West and the South, even though the Northeast had the highest overall rates," Dr. Lynch said. "Similarly, although the numbers are highest in white people, relative to baseline, the highest increases were in minority populations," he noted.

"This is tragic and sad and that there is no easy answer," Dr. Lynch said. "I think there has to be a multifaceted effort that would include early intervention, availability of naloxone and fentanyl test strips, needle exchange programs and making sure people with substance use disorders have access to treatment and social services."

SOURCE: https://bit.ly/34hNCmy JAMA Psychiatry, online May 26, 2021.

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