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How Overdose Increases During COVID-19 Are Impacting Local Emergency Rooms

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Although emergency room (ER) visits have declined by about 40 percent since the start of the pandemic, visits related to overdose, suicidal thoughts, and other mental health and addiction-related challenges have increased. Tragically, many ER staff do not have the training or the tools necessary to help those with addiction and other mental health problems.

Hospital Emergency Rooms Struggle with Overdose Spike During Pandemic” was a recently featured topic of the NPR radio show All Things Considered. One guest was Dr. Mark Rosenberg, president of the American College of Emergency Physicians.

According to Rosenberg, if ER doctors release overdose patients without further treatment, those patients “are a hundred times more likely to die within the year.”

What is Causing the Increase in Overdose Deaths?

Over 81,000 people died in the U.S. from overdose between May 2019 and May 2020. This is the highest number of overdose deaths ever reported in a 12-month period, according to the CDC. Overdose deaths recorded since May 2020 show the numbers are increasing at an accelerated rate.

In our recent blog, Update on OD Increases During COVID-19, we reported the results of a Kaiser Foundation poll taken in July 2020, in which respondents blamed COVID-19 for increasing economic distress and problems related to social isolation, including depression and anxiety. Many studies have found such stressors to increase an individual’s likelihood of misusing and abusing addictive substances, as well as increase the risk of relapse for those in recovery.

In that blog, we also cited a recent article in The Hill quoting CDC Director Robert Redfield, who said, “The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard.”

Trends in Emergency Room Visits

Since March 2020, the COVID-19 pandemic has caused unprecedented changes in how people across the globe are living their lives. Because the pandemic is just over a year old, data is limited. However, one major study, entitled Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic was recently published in the Journal of the American Medical Association (JAMA) Psychiatry.

The authors of the study reviewed almost 190 million emergency room visits to determine whether the number of visits related to mental health issues, suicide attempts, overdose, and violence has changed since the onset of the COVID-19 pandemic.

When researchers compared data from mid-March through October 2019 to data for the same period in 2020, they found “that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher” during the pandemic.

Study authors concluded emergency rooms need to better “integrate mental health, substance use, and violence screening and prevention services into response activities during public health crises.”

How Have ERs Responded to Increased Overdose Visits?

As more people are experiencing mental health and substance abuse crises, experts warn that many emergency department staff, as well as the procedures they follow, do not adequately address the needs of these patients.
Dr. Rosenberg explains, “Emergency physicians have always been able to treat the overdose, but we did not have the tools to treat the addiction or the dependency.”

Part of the blame, according to Rosenberg, is a combination of regulatory hurdles and the pervasive stigma attached to people who use drugs, both of which have discouraged emergency departments from improving their addiction care.

How One ER Met the Challenge

Distressed over the spike in overdose deaths three years ago, Dr. Stephen Viel, head of the emergency team at Halifax Medical Center in Daytona Beach, Florida decided emergency room care needed to change.
Dr. Viel instituted major shifts in emergency room procedures, including the following.

Use of buprenorphine

Many ER doctors do not use buprenorphine, which is proven to save lives and avoid relapse. In his interview with NPR, Dr. Mark Rosenberg of the American College of Emergency Physicians stated, “Only one-third of patients get medications for opioid use disorder in the emergency department.”

Adding an addiction counselor to his ER team

Viel added addiction counselor Larry Brooks to his team. Brooks is not only a trained counselor, but he is also in recovery from substance use disorder himself, so has great empathy for what addicted patients are going through. It is imperative that hospital administrators staff emergency rooms with providers who understand addiction and can help patients connect with the treatment resources they need.

Begin addiction care in the ER

As an addiction counselor and a person in recovery, Brooks knows that beginning addiction care in the ER immediately after healthcare staff have stabilized a patient saves lives and prevents future relapse.

Many ER departments release overdose patients without offering any continuing treatment care or additional resources. As a result, these patients often continue the cycle of overdose and death.

Halifax Medical Center has a different plan: start treating the addiction in the ER. As Brooks states, “You’re not going to get kicked right back out the door and go into withdrawal and have to find [more drugs] and then be back here in two hours.”

Kristin M. Holland, Ph.D., MPH is one author of the study on emergency room trends published in JAMA. She hopes data from her study will convince more hospital emergency rooms to make policy changes similar to the ones made by Halifax Medical.

According to Holland, “If people are coming to the emergency department for these outcomes [overdose, mental health, violence], that’s where we need to meet them.”

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