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. 2021 Nov 1:228:108977.
doi: 10.1016/j.drugalcdep.2021.108977. Epub 2021 Aug 28.

The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic

Elisabeth D Root  1 , Svetla Slavova  2 , Marc LaRochelle  3 , Daniel J Feaster  4 , Jennifer Villani  5 , Jolene Defiore-Hyrmer  6 , Nabila El-Bassel  7 , Rosa Ergas  8 , Kitty Gelberg  9 , Rebecca Jackson  10 , Kara Manchester  11 , Megha Parikh  8 , Peter Rock  12 , Sharon L Walsh  13
Affiliations

The impact of the national stay-at-home order on emergency department visits for suspected opioid overdose during the first wave of the COVID-19 pandemic

Elisabeth D Root et al. Drug Alcohol Depend. .

Abstract

Background: Although national syndromic surveillance data reported declines in emergency department (ED) visits after the declaration of the national stay-at-home order for COVID-19, little is known whether these declines were observed for suspected opioid overdose.

Methods: This interrupted time series study used syndromic surveillance data from four states participating in the HEALing Communities Study: Kentucky, Massachusetts, New York, and Ohio. All ED encounters for suspected opioid overdose (n = 48,301) occurring during the first 31 weeks of 2020 were included. We examined the impact of the national public health emergency for COVID-19 (declared on March 14, 2020) on trends in ED encounters for suspected opioid overdose.

Results: Three of four states (Massachusetts, New York and Ohio) experienced a statistically significant immediate decline in the rate of ED encounters for suspected opioid overdose (per 100,000) after the nationwide public health emergency declaration (MA: -0.99; 95 % CI: -1.75, -0.24; NY: -0.10; 95 % CI, -0.20, 0.0; OH: -0.33, 95 % CI: -0.58, -0.07). After this date, Ohio and Kentucky experienced a sustained rate of increase for a 13-week period. New York experienced a decrease in the rate of ED encounters for a 10-week period, after which the rate began to increase. In Massachusetts after a significant immediate decline in the rate of ED encounters, there was no significant difference in the rate of change for a 6-week period, followed by an immediate increase in the ED rate to higher than pre-COVID levels.

Conclusions: The heterogeneity in the trends in ED encounters between the four sites show that the national stay-at-home order had a differential impact on opioid overdose ED presentation in each state.

Keywords: COVID-19; Emergency department encounter; HEALing Communities Study; Opioid use disorder; Segmented regression; Syndromic surveillance.

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Conflict of interest statement

M. LaRochelle reports receiving consulting funds for research paid to his institution by OptumLabs outside the submitted work. All other authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Weekly rate of ED encounters for suspected opioid overdose per 100,000 population, January-August 2020 in Kentucky (o), Massachusetts (x), New York (+), and Ohio (△). Weekly rates are visualized by points; the trends are visualized by the lines and confidence bands and derived from a loess regression using a 7-day window. The vertical line represents the week ending March 14, 2020. Note: Data from New York exclude New York City.
Fig. 2
Fig. 2
Estimated trends in rate of ED encounters for suspected opioid overdose (per 100,000 population) from ITS models, January 1, 2020 to July 31, 2020 for Kentucky (o), Massachusetts (x), New York (+), and Ohio (△). The solid black line indicates the first change point (MMWR week 12). Arrows indicate the state-specific second change points. The vertical line represents the week ending March 14, 2020. Note: Data from New York exclude New York City.
Fig. 3
Fig. 3
Estimated trends in rate of ED encounters per 100,000 population for suspected opioid overdose in HCS communities from ITS models, January 1, 2020 to July 31, 2020 for Kentucky, Massachusetts, New York, and Ohio. Solid lines indicate trends within HCS communities and dashed lines indicate trends for the rest of the state, excluding HCS community data. The thick solid black line indicates the first change point (MMWR week 12). The second set of lines indicate the timing of the second change point for HCS (solid) and non-HCS (dashed) communities. Note: Data from New York exclude New York City.
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References

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