Overdose Calls Slam EMS in Pandemic

Overdose-related cardiac arrests have spiked amid the pandemic, according to an analysis of national emergency medical services (EMS) data.

Between January 1 and August 1, 2020, overdose-related cardiac arrests accounted for 49.5 of every 100,000 EMS activations, a 48.5% increase compared with the weekly average of 2018 and 2019 values, reported Joseph Friedman, MPH, a medical student at the University of California Los Angeles, and colleagues.

Overdose-related cardiac arrests, which typically result in death, started to rise in mid-March before spiking in April at 74.1 per 100,000 EMS calls, or a 123.4% increase from baseline, the team wrote in the study online in JAMA Psychiatry.

“There is a challenge in overdose research where there are long lags associated with traditional database sources like state-level mortality databases,” Friedman told MedPage Today. “We were looking for some way to monitor this now, and EMS data are available in real time.”

As of Oct. 31, 2020, all but nine U.S. states had reported increases in opioid-related mortality, according to the American Medical Association. In provisional CDC data, the number of overdose deaths recorded between January and March of this year totaled 19,416 — almost 3,000 more than in the same quarter last year.

Despite a small decrease in overdose deaths that occurred a few years ago, overdose deaths had been increasing before the pandemic, largely due to increased fentanyl circulating in the drug supply, commented Lewis S. Nelson, MD, of Rutgers New Jersey Medical School in Newark, who was not involved in the research.

“These numbers far exceed any trend that we had been seeing over the past decade,” he told MedPage Today. “They are quite staggering and troubling.”

The pandemic may have disrupted the supply of narcotics for some patients, leading them to consume drugs that have traces of fentanyl or other substances triggering an overdose, Friedman said, adding that the psychological and financial tolls of the pandemic may also be driving people to use substances more often.

“There were lots of reasons to think COVID-19 may exacerbate overdose fatality rates [including] things like increased social isolation,” Friedman said. “Life is getting harder for a large section of the population.”

Nelson agreed that increased social isolation is likely driving the uptick of overdoses if people are using drugs alone without someone there to call EMS or administer naloxone.

For the study, the researchers correlated overdose deaths with social mobility measured through cell phone data, with the steepest decline in mobility seen beginning March 16, dropping 51.8% below baseline by April 13, and slowly increasing to 24.3% below baseline by July 27.

Richard A. Jorgensen, MD, coroner of DuPage County in Wheaton, Illinois, told MedPage Today that the study was consistent with a rise in overdose deaths he has observed in his region. For the first 6 months of 2020, overdose deaths were up 52% from the prior year, with 22 in the last 2 weeks of April and the first week of May alone. Jorgensen said that for comparison, he saw 38 overdose deaths in all of 2012, his first year as coroner in a county of about 920,000 people.

In reviewing overdose deaths, he found that every one of the deaths involved people with a history of mental illness who were living alone and had financial or personal problems they were juggling along with their addiction.

“It became obvious that these are people [for whom] the shelter-in-place is mentally destroying them,” Jorgensen said. “If you think about rehabilitation programs that are successful, virtually every one of them relies on societal help.”

Although the Substance Abuse and Mental Health Services Administration has relaxed prescribing regulations for medication-assisted treatment during the pandemic, many patients still struggle to access treatment.

In the new study, all overdose-related calls remained stable throughout the pandemic months, which suggests “some success with implementing telehealth and liberalizing buprenorphine prescribing and naloxone administration,” Nelson said, noting that certain populations that did not or could not take advantage of these policy changes may be accounting for the rise in overdoses.

Other countries have implemented even more liberal harm-reduction strategies to reduce overdose deaths. For example, Portugal, once Europe’s heroin capital, decriminalized drug use, redirecting funds from enforcement to public health prevention and rehabilitation services.

Proponents of legalization and implementing measures like safe injection sites argue that with a cleaner drug supply, drug users will be less likely to overdose from substances like fentanyl. But both practices are controversial.

“We know the war on drugs is a failing effort, but that doesn’t mean legalizing the use of these drugs is a good one,” Nelson said. “As with safe injection sites, it will be very difficult to implement.”