(PS1-A14) Responding to the Overdose Crisis with Emergency Medicine: Perspectives on People Who Use Drugs During COVID and How Paramedics Are Weathering the Storm

In 2021, the CDC documented a record high of 100,306 lives lost to drug overdose, highlighting the unforeseen impact of the global pandemic on drug use. During the pandemic, people who use drugs (PWUD) experienced a lack of treatment access, feelings of isolation, and an increased risk of relapse. The historic rates of overdose during the pandemic increased burden on the emergency management system. Little is known about how this impacted emergency medicine and first responders. Further, this research lacks sufficient input from southern communities in (1) the experience of PWUD during COVID-19 (2) the harm reduction and emergency care response to intersecting public health crises. First, we conducted semi-structured individual interviews with n=24 PWUD, n=20 harm reductionists, and n=20 first responders (N=64) in order to understand the experience of PWUD during COVID as it relates to overdose and mental health. Second, we conducted field observations during the early stages of the COVID-19 pandemic with paramedics working in specialized community health and mobile outreach branches of emergency medicine to understand how paramedics were responding to substance misuse and mental health emergencies during COVID-19. Interviews were transcribed, coded for relevant themes, and analyzed using applied thematic analysis via Nvivo 12. Field notes from observations were similarly transcribed, deduced into debriefing guides, and analyzed for themes. Several themes emerged from our interviews related to changes experienced by PWUD during COVID-19. First, many of our stakeholders indicated an increase in overdoses at the onset of COVID-19 due to more adulterated substances in general circulation and a heightened experience of psychopathology and isolation among PWUD. In addition, the amount of overdose, suicidality, and other mental health-related calls was indicated to increase. Following our field observations, paramedics involved in community health and/or mobile outreach branches are targeting increases in overdose and mental health related calls directly. These professionals noted increased follow ups with individuals on their caseload due to hardships from COVID-19, as well as a lack of treatment options to provide these clients. Paramedics within community health are responding to these conditions via collaborative care plans with primary care clinics and harm reduction organizations. Key solutions being undertaken in addressing these overdose and mental health crises are (1) dosing of buprenorphine for patients in opiate withdrawal and (2) provision of integrated care alongside community health workers and peer recovery coaches via street outreach. Our findings underscore how COVID-19 negatively impacted PWUD and the need for increased community emergency preparedness and response to treat emergencies and help these vulnerable populations navigate long-term treatment. Future research should explore the clinical impact of community-facing branches of emergency medicine.