Prevalence of SARS-CoV-2 in Patients with Opioid Overdose and Abnormal Chest Imaging

Introduction:
The epidemic of opioid use disorder (OUD) in the United States long preceded the SARS-CoV-2 global pandemic. Complications of OUD are seen in many organ systems. Pulmonary complications, in particular, are numerous, and can arise from both inhalation and systemic use and treatment of opiates (1). These complications include pneumonia, aspiration pneumonia or pneumonitis, cardiogenic edema, non-cardiogenic edema, acute lung injury, pneumothorax, pneumomediastinum, lung abscess, empyema, pulmonary hemorrhage, and septic pulmonary emboli (1, 2, 3). Of those complications, aspiration pneumonia most commonly affects those with OUD who have endured prolonged alterations of consciousness, such as during an overdose (1). Patients presenting to emergency rooms with opioid overdose often have abnormal, nonspecific pulmonary findings on chest imaging that are similar to those seen in patients infected with SARS-CoV-2 (4, 5). Our institution cares for a large number of patients suffering from opioid use disorder (OUD) and also implemented a policy in which all patients with abnormal chest imaging were admitted given a concern that they were at risk of decompensation from SARS-CoV-2.

Methods:
Via a retrospective, observational study we followed all patients admitted to an academic community affiliate hospital from March 1, 2020 through May 5th, 2020 to assess the prevalence of SARS-CoV-2 infection in patients being admitted for OUD with abnormal pulmonary imaging. Three timeframes were selected for analysis: a time during the SARS-CoV-2 pandemic, when a shelter in place (SIP) order was in effect: 3/23/20-4/22/20; the preceding 30 days, (pre-SIP): 2/22/20-3/22/20; and, a comparison period in 2019 (2019): 3/23/10-4/22/19.

Results:
During SIP, 365 patients were admitted, compared to 244 in PreSIP and 169 in 2019. The difference in admissions between SIP and PreSIP was statistically significant. Of the patients admitted after an opioid overdose with abnormal chest x-ray (CXR) or computed tomography scan (CT) who were tested for SARS-CoV-2, only 13% tested positive. This implies that screening radiography studies for SARS-CoV-2 in this population is neither sensitive or specific for the infection.

Conclusion:
There was no clinically significant difference in incidence of abnormal findings on pulmonary imaging between patients who tested positive or negative for SARS-CoV-2, suggesting that chest imaging may be a less helpful diagnostic for SARS-CoV-2 in patients presenting with opioid overdose. Our data also suggests hospital resources may have been overutilized in this specific patient population.

References:
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2. Gotway MB, Marder SR, Hanks DK, et al. Thoracic Complications of Illicit Drug Use: An Organ System Approach. RadioGraphics. 2002;22(Special issue):S119-S135.
3. Hossain R, Almeida RR, Natcheva H, et al. Complications of Intravenous Substance Use Disorders (SUDs). Journal of Thoracic Imaging. 2018;33(2).
4. Bernheim A, Mei X, Huang M, et al. Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection. Radiology. 2020;295(3):200463.
5. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. American Journal of Roentgenology. 2020;215(1):87-93.