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. 2022 Sep;1(1):100007.
doi: 10.1016/j.focus.2022.100007. Epub 2022 Jun 16.

Opioid Overdoses Increase at Home During the COVID-19 Stay-At-Home Order Period in Cook County, Illinois

Chris Delcher  1   2 , Daniel R Harris  1   2 , Nicholas Anthony  1   2 , Mojde Mir  3
Affiliations

Opioid Overdoses Increase at Home During the COVID-19 Stay-At-Home Order Period in Cook County, Illinois

Chris Delcher et al. AJPM Focus. 2022 Sep.

Erratum in

  • Errata.
    [No authors listed] [No authors listed] AJPM Focus. 2023 Jun;2(2):100098. doi: 10.1016/j.focus.2023.100098. Epub 2023 Apr 18. AJPM Focus. 2023. PMID: 37091224 Free PMC article.

Abstract

Introduction: Stay-at-home orders during the COVID-19 pandemic decreased population mobility to reduce SARS-CoV-2 infection rates. We empirically tested the hypothesis that this public health measure was associated with a higher likelihood of opioid- and stimulant-involved deaths occurring in homes located in Cook County, Illinois.

Methods: The stay-at-home period was from March 21, 2020 to May 30, 2020. We analyzed overdose data from the Cook County Medical Examiner's Office using a death location description from case investigations categorized as home, medical, motel, scene, and other. Two groups of decedents were defined as either having an opioid or stimulant listed in the primary cause of death field. We modeled a weekly time series to detect changes in deaths (number) and trends during segmented time periods. Chi-square or Fisher's exact and adjusted logistic regression was used for testing the differences between the stay-at-home and a 13-week preceding period.

Results: There were 4,169 and 2,012 opioid- and stimulant-involved deaths, respectively, from 2018 to 2020. Both groups were demographically similar: 75% male, 52% White, and aged 45 years (mean). In the 13 weeks before stay-at-home orders, 51% of opioid-involved deaths occurred in homes, which increased to 59% (p<0.0001) during the 10 weeks of the order and decreased back to 51% in the 18 weeks after the order expired. For stimulant-involved deaths, 51% were residential immediately before the orders, with a nonsignificant increase to 52% during the stay-at-home period. Before the pandemic, there were 20 deaths/week, increasing to 37 deaths/week (p<0.0001) during stay-at-home enactment. Deaths involving fentanyl among the opioid-involved group increased from 76% to 89%, whereas those involving heroin decreased from 55% to 37%. The adjusted OR for opioid-involved fatal overdoses occurring at home during this period compared with that occurring the 13 weeks before was 1.37 (95% CI=1.05, 1.79).

Conclusions: The likelihood of a death occurring at home, especially for people using opioids, increased during the stay-at-home order period. Findings have implications for mitigating overdose risks during social isolation.

Keywords: COVID-19; Opioids; fatal overdoses; stimulants.

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Figures

Figure 1
Figure 1
(A) Opioid- and stimulant-involved deaths, weekly counts, Cook County and Illinois, 2018–2020. (B) Percentage of opioid-involved deaths with fentanyl and heroin present. Linear and AR trendlines are shown with estimated level changes in periods (only the opioids and fentanyl series had a seasonal autoregressive component). The 10-week stay-at-home order period (March 21, 2020–May 30, 2020) is shown with the darkest shading.
Figure 2
Figure 2
Percentage of opioid- and stimulant-involved fatal overdoses attributed to homes by period, Cook County, Illinois, 2018–2020. The stay-at-home order period was Mar 21, 2020–May 30, 2020.
See this image and copyright information in PMC

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