Steady Increase Seen in Cardiac Arrest−Related Overdoses During COVID-19 Pandemic

Overdose-related cardiac arrests rose consistently in the first few months of the coronavirus disease 2019 (COVID-19) pandemic, coming in at a 48.5% increase above baseline through August 1, according to results published today in JAMA Psychiatry.

Following concern that the urgency of the pandemic could get in the way of efforts to thwart the overdose epidemic, which caused over 70,000 deaths in 2019 alone, the investigators of this study “leveraged a large, national EMS [emergency medical services] database to characterize trends in overdose mortality fueled by the pandemic." State databases, they claimed, have too long of a lag time compared with the near–real-time trends that EMS databases can provide.

Their retrospective observational study harnessed data from the National EMS Information System, which comprises over 10,000 EMS agencies from 47 states, totaling “more than 80% of EMS activations nationally in 2020.” They looked at the following:

• Weekly overdose-related cardiac arrests
• Overdose-related EMS activations
• Outcomes per EMS activations

Numbers in 2020 were compared with a combined 2018/2019 baseline average, and excess values were put up against a cell phone-based mobility score, which is how the authors evaluated social distancing.

Total EMS activations rose almost 38% between 2018 (n = 22,178,238) and 2019 (n = 30,560,105) before falling off by 28% in 2020 (n = 21,904,630). Most involved calls for female patients (52.1%, 51.8%, and 50.5%, respectively) of White ethnicity (64.8%, 63.4%, and 63.2%).

Additionally, during April, right at the beginning of the pandemic, there was a 123.4% spike from baseline in overdose-related cardiac arrests. This peaked at 74.1 cases per 100,000 EMS activations by May 4 before dropping to 48.7 cases per 100,000 EMS activations by July 27—which was still 53.7% above baseline.

The trend of elevated overdose-related cardiac arrests continued through August 1, which saw 49.5 cases per 100,000 EMS activations, equating to 48.5% above baseline. Simultaneously, mobility dropped by 51.8% through April 13 and 24.3% through July 27.

“Peak rates in May 2020 were more than double the baseline from 2018 and 2019, and overall 2020 values were elevated by approximately 50%,” the authors noted.

The concurrent drop in mobility as a result of the pandemic, they posit, could be an underlying cause of the recent rise in fatal overdoses, even their acceleration. This is in addition to increases in substance abuse, toxification of the drug supply, and lack of access to treatment, all of which “could increase the lethality of each overdose incident.”

“Shifts observed here suggest that measures to address the pandemic have largely failed to mitigate overdose risk,” the authors concluded. “These trends implicate investments in substance use treatment, harm reduction, and structural drivers of overdose as core elements of COVID-19 response.”

However, their results should be confirmed through additional study, especially in light of the limitation that as EMS-observed overdose proportions shift, the findings could be biased up or down.

Reference

Friedman J, Beletsky L, Schriger DL. Overdose-related cardiac arrests observed by emergency medical services during the US COVID-19 pandemic. JAMA Psychiatry. Published online December 3, 2020. doi:10.1001/jamapsychiatry.2020.42148