There has been a sharp increase in overdose-related cardiac arrests in the US during the COVID-19 pandemic, a new analysis shows.
Overall rates in 2020 were elevated above the baseline from 2018 and 2019 by about 50%, the data show.
“Our results suggest that overdoses may be strongly on the rise in 2020, and efforts to combat the COVID-19 pandemic have not been effective at reducing overdoses,” Joseph Friedman, MPH, MD/PhD student, Medical Scientist Training Program, University of California, Los Angeles, told Medscape Medical News.
“We need to invest heavily in substance use treatment, harm reduction, and the structural drivers of overdose as core elements of the COVID-19 response,” said Friedman, who coauthored the study with UCLA colleague David Schriger, MD, MPH, and Leo Beletsky, JD, MPH, Northeastern University School of Law, Boston, Massachusetts.
The study was published as a research letter December 3 in JAMA Psychiatry.
Social Isolation a Key Driver
Emergency medical services (EMS) data are available in near real-time, providing a novel source of up-to-date information to monitor epidemiologic shifts during the COVID-19 pandemic.
For the study, the researchers leveraged data from the National EMS Information System (NEMSIS), a large registry of over 10,000 EMS agencies in 47 states that represent over 80% of all EMS calls nationally in 2020. They used the data to track shifts in overdose-related cardiac arrests observed by EMS.
They found clear evidence of a large-scale uptick in overdose-related deaths during the COVID-19 pandemic.
The overall rate of overdose-related cardiac arrests in 2020 was about 50% higher than trends observed during 2018 and 2019, including a maximum peak of 123% above baseline reached in early May.
All overdose-related incidents (fatal and nonfatal) were elevated in 2020, by about 17% above baseline. However, there were larger increases in fatal overdose-related incidents, compared to all incidents, which may suggest a rising case fatality rate, the authors say.
The observed trends line up in time with reductions in mobility (a metric of social interaction), as measured using cell phone data, they note.
“Many of the trends predicted by experts at the beginning of the pandemic could cause these shifts. Increases in social isolation likely play an important role, as people using [drugs] alone are less likely to receive help when they need it. Also shifts in the drug supply, and reduced access to healthcare and treatment,” said Friedman.
“We need to undertake short- and long-term strategies to combat the rising tide of overdose mortality in the United States,” he added.
In the short term, Friedman suggested reducing financial and logistical barriers for accessing a safe opioid supply. Such measures include allowing pharmacies to dispense methadone, allowing all physicians to prescribe buprenorphine without a special waiver, and releasing emergency funds to make these medications universally affordable.
“In the longer term, we should acknowledge that overdose is a symptom of structural problems in the US. We need to invest in making employment, housing, education, and healthcare accessible to all to address the upstream drivers of overdose,” he added.
The study had no commercial funding. The authors have disclosed no relevant financial relationships.
JAMA Psychiatry. Published online December 3, 2020. Research Letter