Many Americans stayed away from the emergency room when the nation went under lockdown for fear of contracting COVID-19 at the hospital. While this led to an overall decline in emergency department visits, a recent study shows weekly trips to the ER for drug overdoses were higher in 2020 than in 2019.
Researchers from the Centers for Disease Control and Prevention studied more than 180 million ER visits from Dec. 30, 2018, to Oct. 10, 2020, and found that weekly counts of all drug overdoses were up to 45% higher in 2020 than in 2019, according to the study published Feb. 3 in the peer-reviewed JAMA Psychiatry. Opioid overdoses, specifically, increased about 29% compared to before the pandemic.
Overall visits to the emergency room plummeted when COVID-19 lockdown measures were implemented in March 2020, decreasing about 43% compared to the same timeframe in 2019. However, drug overdoses experienced only a slight decrease from March 29 to April 11, about 4% compared to 2019, before increasing again.
“That all drug and opioid overdose emergency department visits did not decrease in a similar manner to other emergency department visits is especially compelling, suggesting an increase in overdose burden during the pandemic,” study authors said.
The study comes a few months after the CDC alerted in December to an increase in drug overdose deaths that may have been accelerated by the pandemic, reporting more than 81,000 deaths in a 12-month period ending in May 2020, an 18.2% increase from the prior year. The agency said synthetic opioids are the primary driver of overdose deaths, increasing more than 38% compared to 12 months ending in June 2019.
“I’m not surprised to see data like this come out,” Dr. Patrick Marshalek, an addictions specialist and associate professor at West Virginia University’s School of Medicine. The pandemic “is breeding this and making it more likely to happen with a wide variety of substances.”
Anxiety, stress, depression and isolation induced by the pressures of the pandemic combined with a sudden lack of resources to seek treatment may have caused many people to relapse in their substance use disorder leading to an increase in overdoses in 2020, addiction experts say.
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Dr. Owen Lander, medical director of the West Virginia University Medicine J.W. Ruby Memorial Hospital Emergency Department, said he’s seen an uptick of relapses in his emergency room as people with a long period of abstinence don’t recognize their tolerance is much lower.
He speculated more relapses happened as the pandemic temporarily shut down treatment centers, clinics and other resources. Although numerous doctor’s offices relied on telemedicine to resume daily functions, Lander said many people who struggle with substance use disorders don’t have access to this.
“A lot of these folks don’t have access to telemedicine infrastructure,” he said. “A large part of their recovery efforts has relied on face-to-face connection with a therapist or support group and that lack of face-to-face is a real challenge.”
It’s not just patients who live in rural West Virginia. Dr. Jeanmarie Perrone, director of the center for addiction medicine and policy at the University of Pennsylvania’s Perelman School of Medicine, said many of her patients in poor Philadelphia neighborhoods don’t have access to broadband, either.
She said the sharp rise in overdoses could also be attributed to the mounting presence of fentanyl as dealers facing supply problems during the pandemic mix the substance into heroin, cocaine and methamphetamine.
Although the study is concerning, it only captures a small fraction of the whole picture, Lander said. For every overdose that makes it to the emergency room, there are more overdoses that don’t, either because the person was revived at home or died. And for every one of those overdoses, there are multiple people who are falling further into their substance use disorders behind closed doors.
“People who show up in the emergency department for an acute overdose are the tip of the iceberg,” Lander said.
The study highlights the emergency department’s important role in the health care system by not only stabilizing a patient but also treating them and referring them to other resources, experts say.
It also underscores the need for incorporating effective prevention strategies more broadly in COVID-19 response efforts, such as policies that can reduce economic burden or increase messaging around mental illness.
“Our health system here has been set up to wait for years for something bad to happen,” Marshalek said. “An ounce of prevention is worth a pound of cure.”
Follow Adrianna Rodriguez on Twitter: @AdriannaUSAT.
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