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Big spikes in overdose cardiac arrests, opioid deaths amid COVID-19

Two new JAMA studies reveal startling jumps in overdose-related cardiac arrests and fatal opioid overdoses during the COVID-19 pandemic.

Record overdose-linked cardiac arrests

The first study, led by University of California, Los Angeles, researchers and published yesterday in JAMA Psychiatry, involved 33.4 million patient emergency medical services (EMS) encounters from the beginning of the pandemic to May 2020 in the US National EMS Information System, a database of EMS visits from more than 11,000 agencies in 49 states. These visits made up more than 87% of all EMS encounters in 2020.

The number of overdose-related cardiac arrests was compared with those from 2018 and 2019 and with provisional aggregate death data from the Centers for Disease Control and Prevention (CDC) from 2018 through July 2020.

Overdose-related cardiac arrests climbed 42.1% across the United States in 2020. Despite lower baseline rates, the largest increases occurred among Black (50.3%) and Latin American (49.7%) patients, those living in socioeconomically disadvantaged communities (46.4%), and in Pacific states (63.8%).

Overdose-linked cardiac arrests began rising in April 2020, reaching a record single-month total of 2,112 in May. While EMS calls fell 17.7% from March to April, overdose-related cardiac arrests rose 98.3% in May. Then the rate began slowly falling, reaching a 21.4% increase over baseline in December. Over that time, overdose-related cardiac arrests stayed high throughout 2020, at 38.4% above baseline.

Structural racism, US drug policy

EMS overdose death data jibed well with those from the CDC (r, 0.98), which showed a spike in overdose deaths from May 2019 through May 2020, at 81,684. When the COVID-19 pandemic and its attendant social isolation and instability took hold, the United States was already several decades into an accelerating overdose crisis fueled by the more easily smuggled opioid fentanyl, with a 2019 total of more than 70,000 overdoses.  

If the historical link between EMS observed and total deaths holds true, the authors said, the CDC could eventually report roughly 90,632 overdose deaths for all of 2020. Of the 33.4 million total EMS visits in 2020, 50.2% involved female patients, and 48.8% involved White patients.

The researchers called for “increased resources for substance use treatment; harm reduction; reducing the toxicity of the opioid supply; and systems-level approaches to addressing the structural, social, and economic drivers of overdose risk.”

They added that the fundamental drivers of inequality in overdose death rates and other public health outcomes must be addressed.

“Structural racism in the health care system and US drug policy has harmed both White communities and communities of color in different ways and at distinct historical moments,” the researchers concluded.

“As survival becomes more difficult for millions of people in the US, economic investments in ensuring adequate employment, housing, healthy food, and health care for all will be needed to avoid exacerbating these root drivers of overdose, as well other so-called deaths of despair, such as suicide.”

Fatal opioid overdoses up 320% in young people

In the second study, published yesterday in JAMA Network Open, a team led by St. Michael’s Hospital researchers in Toronto conducted a time series analysis of opioid-related deaths among people 15 years and older in Ontario from Jan 1, 2018, to Sep 20, 2020. Then they compared fatal opioid overdoses from Mar 16 to Sep 15, 2020, the same period in 2019, and from Sep 14, 2019, to Mar 15, 2020.

Over the entire study period, weekly opioid-associated deaths rose 135%, with the fastest growth among people younger than 35 years (320% increase). During that time, 2,774 people (73.4% male, 47.2% 35 to 54 years) died of an opioid overdose.

In the first 6 months of the COVID-19 pandemic, 1,237 people died after overdosing on an opioid, compared with 766 in the first 6 months of 2019 and 772 from Sep 14, 2019, to Mar 15, 2020.

Most overdose characteristics were similar in the three periods, but the proportion of opioid deaths among men rose from 68.5% between Sep 14, 2019, and Mar 15, 2020, to 76.7% in the pandemic period. Over that same period, the prevalence of fentanyl rose from 76.0% to 85.4%, while that of stimulants climbed from 62.9% to 71.1%.

In the first 6 months of the coronavirus pandemic, the authors observed, an extra 17,843 years of life were lost owing to opioid overdoses compared with the previous 6 months. “The rising rates of harm among young adults as well as the increased contributions of fentanyl and stimulants to these deaths emphasize the urgent need for low-barrier access to evidence-based harm reduction services and treatment for opioid use disorder in all jurisdictions” that are grappling with epidemics of both overdoses and COVID-19, they wrote.  

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