ABSTRACT
Study Objectives: To identify changes in emergency department (ED) visits for opioid-related diagnoses, opioid overdose, and the use of buprenorphine in EDs during the SARS-CoV-2 pandemic. Methods: Electronic health data was collected from 14 geographically distinct emergency departments for ED visits between August 31, 2019 and August 30, 2020. Variables collected include age, sex, race, ICD-10 discharge codes, buprenorphine administrations, buprenorphine prescriptions and SARS-CoV-2 hospital admission rate. The category of opioid-related diagnoses included ED visits with ICD-10 codes for opioid use disorder, opioid dependence, opioid withdrawal, opioid overdose and/or opioid-related infection. Opioid-related infection visits were tabulated as ED visits with ICD-10 code for abscess, cellulitis, endocarditis or osteomyelitis and concurrent ICD-10 code of opioid-related diagnosis for the current ED visit or in the medical history. We used descriptive statistics and paired t-test to evaluate for differences in ED visits for opioid-related diagnoses, opioid overdose and rate of buprenorphine administrations and/or prescriptions between in visit with opioid-related diagnosis between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020. Spearman correlation was used to assess the association of outcomes with hospital SARS-CoV-2 burden from January 1, 2020 through August 30, 2020. Results: We collected information on a total of 911,738 ED visits between August 31, 2019- August 30, 2020 from 14 EDs Total ED visits with opioid-related diagnoses by ICD-10 code were 9,788, including 3,198 for opioid overdose, 1,745 for opioid withdrawal, and 431 for opioid-related infection (Figure 1). Between August 31, 2019-February 29, 2020 and March 1, 2020-August 30, 2020 (N = 13 sites), there was an increase in ED visits for OUD-related visits per 10,000 visits (130.8 (SE: 24.2) vs 101.8 (SE: 21.8);p=0.002) and an increase in ED visits for opioid overdose per 10,000 ED visits (40.8 (SE: 10.3) vs 27.4 (SE: 6.1);p=0.02). No change was detected in the rate of buprenorphine administration and/or prescriptions: 25.8 (SE: 5.3) vs 25.1 (5.5);p=0.80. From January to August 2020, significant correlations were observed between inpatient hospital SARS-CoV-2 rates and ED visits with a positive correlation between opioid-related diagnoses per 10,000 (Spearman r=0.92, p= <0.0001) and opioid overdose per 10,000 visits (r=0.90, p=<0.0001);a negative correlation was found for the rate of ED administration and/or prescription of buprenorphine (r=-0.37, p=0.03). Conclusions: ED visits for opioid-related diagnoses and opioid overdose per 10,000 ED visits increased in EDs between March 1, 2020 – August 30, 2020 compared to the preceding 6 months and correlated with inpatient SARS-CoV-2 burden. Although the overall rate of buprenorphine administered and/or prescribed from the ED highlights a significant practice change in EDs over recent years, buprenorphine provision in EDs did not increase despite likely treatment service disruptions during this period of SARS-CoV-2. [Formula presented]