• Jennifer Rosenbaum, Nicole Lucas, Gregory Zandrow, Wayne A Satz, Derek Isenberg, Joseph D'Orazio, Nina T Gentile, and Kraftin E Schreyer.
• Department of Emergency Medicine, Temple University Hospital, 1316 W. Ontario Street, 10(th) Floor Jones Hall, Philadelphia, PA 19140, United States. Electronic address: Jennifer.Rosenbaum@tuhs.temple.edu.
• Am J Emerg Med. 2021 Mar 1; 41: 515451-54.

IntroductionSince the beginning of the novel coronavirus (COVID-19) pandemic in the United States, there have been concerns about the potential impact of the pandemic on persons with opioid use disorder. Shelter-in-place (SIP) orders, which aimed to reduce the spread and scope of the virus, likely also impacted this patient population. This study aims to assess the role of the COVID-19 pandemic on the incidence of opioid overdose before and after a SIP order.MethodsA retrospective review of the incidence of opioid overdoses in an urban three-hospital system was conducted. Comparisons were made between the first 100 days of a city-wide SIP order during the COVID-19 pandemic and the 100 days during the COVID-19 pandemic preceding the SIP order (Pre-SIP). Differences in observed incidence and expected incidence during the SIP period were evaluated using a Fisher's Exact test.ResultsTotal patient visits decreased 22% from 46,078 during the Pre-SIP period to 35,971 during the SIP period. A total of 1551 opioid overdoses were evaluated during the SIP period, compared to 1665 opioid overdoses during the Pre-SIP period, consistent with a 6.8% decline. A Fisher's Exact Test demonstrated a p < 0.0001, with a corresponding Odds Ratio of 1.20 with a 95% confidence interval (1.12;1.29).ConclusionThe COVID-19 pandemic and the associated SIP order were associated with a statistically and clinically significant increase in the proportion of opioid overdoses in relation to the overall change in total ED visits.Copyright © 2020 Elsevier Inc. All rights reserved.

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