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. 2021 Dec:50:472-476.
doi: 10.1016/j.ajem.2021.08.058. Epub 2021 Aug 26.

Impact of COVID-19 pandemic on emergency department substance use screens and overdose presentations

Kira Chandran  1 , Maryann Mazer-Amirshahi  2 , Nikash Shankar  3 , Sameer Desale  4 , Lewis Nelson  5 , Mihriye Mete  4
Affiliations

Impact of COVID-19 pandemic on emergency department substance use screens and overdose presentations

Kira Chandran et al. Am J Emerg Med. 2021 Dec.

Abstract

Background: The COVID-19 pandemic can exacerbate underlying substance use disorder and has impacted this vulnerable population in a variety of ways. There are limited data regarding how this pandemic has impacted emergency department (ED) patient presentations.

Methods: We extracted data on ED visits from the electronic health record (EHR) of a large healthcare system in the Washington, DC/Baltimore, MD metropolitan area. The dataset includes data from 7 hospitals on ED visits between 11/1/2019-6/30/2020. The health system utilizes a validated screening program for substance use, Screening, Brief Intervention, and Referral to Treatment (SBIRT), for ED patients who are clinically stable and willing to complete screening. We evaluated trends in patients with a positive SBIRT screen and those presenting with a clinical diagnosis of acute alcohol or substance intoxication/overdose before (11/1/19-2/29/2020-pre) and during the first wave of the COVID pandemic (3/1/2020-6/30/2020-post). Data were described using descriptive statistics. Bivariate analyses were conducted using chi-square test and two-sample t-tests. Interrupted time series analysis was used to evaluate the changes in the weekly trends with the start of the pandemic.

Results: There were 107,930 screens performed in the EDs during the study period (61,961 pre, 45,969 post). The population was primarily African American (64.7%) and female (57.1%). Positive SBIRT screens increased from 12.5% to 15.8% during COVID (p < 0.001). Alcohol intoxication presentations increased as a proportion of positive screens from 12.6% to 14.4% (p = 0.001). A higher percentage of screened patients reported problem drinking (AUDIT score ≥ 7) during the pandemic (2.4% pre vs 3.2% post, p < 0.001). Substance intoxication/overdoses among all screened increased from 2.1% to 3.1% (p < 0.001) and as a percentage of positive screens during the pandemic (16.8% to 20%, p < 0.001). The proportion of opioid vs. non-opioid overdoses remained unchanged before (67%) and during the pandemic (64%, p = 0.33).

Discussion: There was an increase in the proportion of positive SBIRT screens and visits for acute overdoses and intoxication during the first wave of the COVID-19 pandemic. Additional research should focus on mitigation strategies to address substance use during this vulnerable time.

Keywords: COVID-19; Emergency department; Substance use.

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Conflict of interest statement

Declaration of Competing Interest The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent- licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Kira Chandran, Maryann Mazer-Amirshahi, Nikash Shankar, Sameer Desale, Lewis Nelson, Mihriye Mete.

Figures

Fig. 1
Fig. 1
Spline Regression Analysis of Weekly Percent SBIRT Screens: shows a spline regression analysis of the weekly percent positive screens of all emergency department visits between 11/1/2019–6/30/2020 with a time interruption at week 19. The pre-slope coefficient was 0.02 (standard error (SE) = 0.03) and the post-slope coefficient was 0.37 (SE = 0.06) showing that positive screens were relatively stable with a weekly non-significant increase by 0.02 percentage points (p = 0.50) in the pre-period but showed a significantly larger weekly increase by 0.37 percentage points in the post-period (p < 0.001).
Fig. 2
Fig. 2
Spline Regression Analysis of Weekly Percent SBIRT Screens by Sex: shows a significant increase in weekly positive screens for females in the post-period (3/1/20–6/30/20) in comparison with the pre-period (11/1/19–2/29/20); (p < 0.001).
Fig. 3
Fig. 3
Spline Regression Analysis of Weekly Percent SBIRT Screens by Race: presents weekly predictive margins for the percentage of SBIRT positive screens for three race groups across 36 weeks with a spline at week = 19. All race groups show a steeper increase in the post-period compared to the pre-period.
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