(85) Opioid Overdoses During the 2020 COVID-19 Pandemic

Background: The opioid epidemic is a major public health concern in the United States. In 2020 the COVID-19 pandemic changed the delivery of healthcare and majorly impacted mental health. While some research has been performed to investigate the impact of the COVID-19 pandemic on the opioid epidemic, further examination is warranted. We hope to add to the literature utilizing a large and unique population including a high percentage of underrepresented patients (including a large Hispanic population), urban and rural centers, and in multiple western states.

Objective: The objective of this study was to investigate the impact of the COVID-19 pandemic on the incidence of opioid overdoses in a multi-center health network and to investigate the demographics of these patients.

Methods: A retrospective chart review was done to identify patients who presented to the emergency department (ED) or were admitted for opioid overdose between January 2016 – December 2020 within a multi-center health network. Opioid overdose was identified via ICD-10 codes. Opioid overdoses from January 2019 – December 2019 (pre-pandemic) were compared to January 2020 – December 2020 (first year of pandemic). Demographic data including sex, age, race/ethnicity, and fatal vs. non-fatal opioid overdoses were collected. Temporal trends and comparison between pre-pandemic and pandemic were evaluated. Students t-test or Mann-Whitney test and Chi-Square or Fisher Exact test were used to compare continuous and categorical variables respectively. Poisson regression was used to compare the overdose incidences between groups.

Results: Of the 19,722 patients included, the mean age was 52 years and 51% were female. The aggregate incidence of opioid overdose was 9.2 per 1000 patients admitted or seen in the ED. It was higher in males compared to females (10.3 vs 8.3 per 1000 patients admitted or seen in the ED, p< 0.001). White individuals (10.5) had the highest incidence, followed by Native Americans (9.2), Black individuals (7.8) and Hispanic individuals (7.0) had the lowest incidence of opioid overdoses per 1000 patients. There was a significant increase in the incidence of opioid overdose from 2016 to 2020 (6.1 vs. 6.51 per 1000 patients, p=0.004). Of those with an opioid overdose, a decline was noted in females from 2016-2019 (57%, n=2,139 to 46%, n=1,810, p< 0.001). The number of total opioid overdose deaths increased from 16% in 2016 to 29% in 2020. There was a 9% increase in the incidence of opioid overdose from pre-pandemic to during the pandemic. During the pandemic, the opioid overdose patients were younger (mean ± SD, 49.6 ± 20.1 vs 51.2 ± 20.8 years, p=0.0009) and consisted of significantly more males (54% vs 46%, p=0.020). There was no significant difference by race during the pandemic compared to pre-pandemic. Opioid overdose deaths were significantly higher during the pandemic (1.7% vs 2.7%, p=0.002).

Conclusions: The incidence of opioid overdose presenting to the ED or admitted as an inpatient is higher in males and White individuals and lowest in Hispanic individuals. During the pandemic, there was an increase in the incidence of opioid overdoses and opioid overdose deaths. Patients were younger and more often male. This information is important to understanding healthcare disparities and the impact of COVID-19 on the opioid epidemic.

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