ABSTRACT
BACKGROUNDS: The Covid-19 pandemic offered a unique opportunity to investigate trends in hospitalizations related to psychoactive substance intoxication, since the usual health burden of social use at parties and gatherings was likely to be decreased during lockdowns and curfew periods. Since young adults are the main users of psychoactive substances for experimental and recreational purposes, this study identified and compared hospitalization trends in young adults and adults over 30 years old. METHODS: This national cohort study was conducted using the French hospital discharge database. An interrupted time-series analysis for the period between 2014 and 2020 was performed in two groups: young (age 18-29) and other adults (30+) to ascertain the trends in the monthly incidence of hospitalization related to psychoactive substance intoxication (opiates, cocaine, benzodiazepines, psychostimulants, alcohol and cannabis). Hospitalization characteristics during the first and second lockdown and the period between them were compared to the reference period (from 01/01/2014 to 29/02/2020). RESULTS: Among 1,358,007 stays associated with psychoactive substance intoxication, 215,430 concerned young adults. Compared with adults 30+, hospitalization trends in young adults showed a greater decrease in the number of stays during lockdown, with a maximum decrease of -39% during the first lockdown (1,566 vs. 2,576; CI95%: 2,285-2,868) versus -20% (10,212 vs. 12,894; CI95%: 12,001-13,787) in the second lockdown. Presentations for alcohol intoxication decreased throughout the pandemic, particularly during the second lockdown, while admissions for benzodiazepine intoxication increased during both lockdowns. Admissions for cannabis intoxication increased throughout the entire period. CONCLUSIONS: Lockdowns were associated with fewer hospitalizations related to psychoactive substance intoxication in both age groups, especially among young adults, which might reflect a decrease in social use. Recreational use might therefore be an important target for prevention and risk minimization.
ABSTRACT
Introduction: In this pandemic period, patients usually treated for one or more chronic diseases have faced difficulties in accessing care, voluntarily or not. The aim was to describe the impact of the COVID-19 epidemic on the use of chronic drugs used for cardiovascular diseases and diabetes mellitus in France. Material and methods: We analyzed data from the French nationwide health insurance database (SNDS) for the 17/09/2018 to 20/09/2020 time period. Drugs of interest were antidiabetic and cardiovascular drugs. The number of patients with treatment dispensing, ongoing, interrupted, or initiated treatment were identified for each week. We performed time-series analysis to describe use of drugs during the study period. Unobserved components model method was applied to predict use of drugs and compare it to observed use after 01/03/2020. Results: During the study period, 3,231,618 patients were identified with at least one dispensing for antidiabetic drugs and 14,822,132 patients for cardiovascular drugs. The one-week period preceding the first national lockdown was marked by a sharp spike in the amount of dispensings. Over the lockdown period, levels and trends in dispensings decreased until the very end of lockdown. The estimated overall impact of the lockdown on dispensings appeared limited with a lack ranging around 1-3%. This limited impact did not appear to be accompanied by an increase in the weekly numbers of treatment disruptions during the lockdown period, but with a significant decrease in treatment initiations were observed for almost all drug classes. The increases in treatment disruptions appeared more pronounced with the expected as predicted over the post-lockdown period for statins, almost all antihypertensive drugs and all antidiabetic drugs. Discussion/Conclusion: We were able to observe the great disparity in the care provided during the beginning of the COVID-19 epidemic in France. The COVID-19-related treatment disruptions undoubtedly resulted in increased health risk due to poor or even absent management.
ABSTRACT
Introduction: Incidence of hospitalisations related to psychoactive substance intoxication (H-SPA) might have been differently impacted by the Covid-19 pandemic according to age-groups. This study aimed to describe (i) the incidence of H-SPA during and after the first 2020 lockdown in adults aged 18-29 years or 30+ then (ii) their characteristics specifically associated with the pandemic period by comparing 2020 with 2017-2019 baseline period. Material and methods: This historical cohort study was conducted in adults admitted to the University Hospital of Bordeaux with main or secondary diagnosis codes of intoxication with benzodiazepine, methadone, buprenorphine, codeine, morphine, heroin, cocaine, ecstasy and alcohol. Data were collected locally through the discharge database. Incidence and characteristics of H-SPA were described according to patients age, in 2020 before (01/01-16/03), during (17/03-10/05), and after the first lockdown (11/05-31/07). Results: Among the 5824 stays included over the study period, SPA most involved were alcohol and benzodiazepines. Compared to baseline, the decrease in H-SPA's incidence was more important in young adults (-40%;nbaseline = 450) in comparison to those aged 30+ (-18%;nbaseline = 1,101) during the pandemic period, especially during the lockdown compared to 2017 (-59%;n2017 = 145 vs-35%;n2017 = 166) with far decrease in alcohol and ecstasy intoxications. Seriousness of hospitalization indications was increased regardless of age during the pandemic. Particularly in young adults, the proportion of suicides increased during lockdown compared to the baseline period (almost 50% vs 29%) and the proportion of accidents in context of intoxication (3.5 vs 0.7%) after lockdown. Discussion/Conclusion: The period following lockdown should be considered at risk for hospitalizations due to accident in context of SPA use. Strong decrease in the incidence of H-SPA in young adult during the lockdown highlights the health burden of recreational use of alcohol and ecstasy in this population and the need for prevention.
ABSTRACT
Introduction: At the beginning of the COVID-19 epidemic, the French Addictovigilance Network alerted on the need to facilitate access to methadone, while maintaining the safety of its use, to avoid the occurrence of overdoses and deaths. The impact of the lockdown on methadone-use related hospitalizations (MUH) has not been analyzed at the national level. The objectives of the study were to assess the impact of the lockdowns on the incidence of the MUHs and describe the characteristics of patients and hospitalizations. Material and methods: This retrospective study was conducted on patients hospitalized in France for methadone poisoning (ICD-10: T40.3) between January 2014 and December 2020, using the database of the Programme de Médicalisation des Systèmes d'Information. An interrupted time series using the Unobserved Components Model was performed to predict the monthly incidence of MUHs in 2020 on the basis of previous years data and confronted to MUHs really observed. The characteristics of the patients (age, sex, comorbidities) and hospitalizations (regions, duration of hospitalization, co-consumptions) were described over four time-periods: before lockdown, first lockdown, after-first lockdown, second lockdown. Results: Compared to the predictions, higher incidence of MUHs was found during the first month of lockdown (March) (66 cases vs. 51.3;IC95%: 34-65) and a large increase during the month following the end of the first lockdown (June) (79 cases vs. 61;IC95%: 46-75). Psychiatric comorbidities, psycho-social difficulties and co-consumptions (alcohol, cannabis, cocaine) were more observed during first lockdown, whereas patients aged over 30 years old and from Nouvelle-Aquitaine, Occitanie and Bretagne were more concerned after. The second lockdown did not present any particularity. Discussion/Conclusion: First lockdown had a significant impact on the incidence of MUHs. These results converge with the data from the reinforced national monitoring showing that methadone was the first substance involved in overdoses and deaths during and after the first lockdown [1].