ED Visits for Opioid Overdose Skyrocket During Pandemic, Researchers Find
Opioid overdose visits to emergency departments rose nearly 30 percent in 2020, according to an analysis of data collected in conjunction with an NIH Collaboratory research project.
The EMBED Demonstration Project was set up as a multicenter pragmatic trial to evaluate the effect of clinical decision support on rates of ED-initiated buprenorphine/naloxone and referral for ongoing medication-assisted treatment for patients with opioid use disorder.
The overdose study accessed data from 25 emergency departments in Alabama, Colorado, Connecticut, Massachusetts, North Carolina, and Rhode Island. Five of the six healthcare systems in the study are participating in EMBED. An amended study protocol enabled the researchers to collect the data as part of an effort to better understand the impact of the COVID-19 pandemic on trial enrollment. The researchers’ paper was published ahead of print this month in the Annals of Emergency Medicine.
EMBED is supported within the NIH Collaboratory by a cooperative agreement from the National Institute on Drug Abuse and receives logistical and technical support from the NIH Collaboratory Coordinating Center.
The paper noted that although some communities have reported increased opioid overdose rates, the extent and subsequent changes in emergency department utilization following a nonfatal opioid overdose during COVID-19 remains unknown. Looking at data from 25 EDs from January 2018 to December 2020, researchers compared overdose visit counts and rates per 100 all-cause ED visits during COVID-19 compared to levels predicted based on 2018-2019 visits.
Overdose visit counts increased by 10.5 percent in 2020 compared to 2018-2019 despite a 14 percent decline in all-cause ED visits, the researchers found. Opioid overdose rates increased 28.5 percent in 2020. Their conclusion is that “despite decreases in ED visits for other medical emergencies, the number and rates of opioid overdose-related ED visits in six healthcare systems increased during 2020, suggesting a widespread worsening in opioid-related complications during COVID-19. Expanded community and hospital-based interventions are needed to support people with OUD and save lives during COVID-19.”
Although the research team described some limitations of their study, they noted it was “able to leverage a previously established research collaboration to analyze opioid overdose-related ED visits across multiple U.S.-based health systems in accordance with epidemiologic outbreak-detection methods. The real-time capture of opioid overdose visits across multiple institutions is a unique strength of our study, as comprehensive surveillance and claims data are not yet available, and previously published opioid overdose rates during COVID-19 have been limited to single healthcare systems or proxy outcomes, including the administration of naloxone by EMS or estimated fatal drug overdose rates.”
The team noted that further research is needed to determine the patient- and community-level factors associated with regional differences in rates of ED visits for opioid overdose.
The U.S. Department of Health & Human Services has recognized that meeting the challenges of the opioid crisis requires improvements in standardization of key metrics and indicators as well as better registries and more robust linkages to bridge gaps between data sources.
A 2020 HHS report highlighted several efforts under way to improve the data infrastructure around addressing opioid use disorder (OUD).
In 2017, HHS launched a 5-point strategy to combat the opioid crisis, and one of the five points recognizes the need for better data to inform research and the public health response as the crisis evolves. HHS noted that “the data infrastructure (how data are produced and managed) and the quality and timeliness of the data can make research a challenge.”
Under the Office of the Secretary Patient-Centered Outcomes Research Trust Fund (OS-PCORTF), the Assistant Secretary for Planning and Evaluation (ASPE) supports and coordinates a range of cross-agency projects that address the opioid crisis by improving the quality and timeliness of outcomes data, increasing collection of patient-reported information, and building linkages to address co-morbid conditions that affect patient outcomes.
