Increase in overdose-associated cardiac arrests during the COVID-19 pandemic

1. Overdose-associated cardiac arrests during the COVID-19 pandemic increased to 98.3% above baseline in May 2020, before declining to 21.4% above baseline in December.

2. Communities that tend to experience fewer cardiac arrests from overdose also experienced the greatest increases in cardiac arrests during the pandemic, including the Latinx and Black communities, and Pacific states.

Evidence Rating Level: 2 (Good)

The United States has been experiencing an overdose crisis for years, and it was predicted that the pandemic would exacerbate the crisis due to heightened isolation and drug supply shifts. The Centers for Disease Control provided preliminary data demonstrating this, with 81,684 deaths from April 2019 to May 2020. However, this data has limitations due to only capturing the first 2-3 months of the lockdown, not separating data by month, and not stratifying by race or other demographics. In recent years, the appearance of toxic fentanyl in the heroin supply has disproportionately affected communities in which overdose cardiac arrests have been lower, such as Black and Latinx communities, and Western states. Therefore, the current study used data from emergency medical services (EMS) to analyze mortality trends from overdose-associated cardiac arrests in the US, taking into account race, geography, urbanicity, and neighbourhood poverty level. This study used data from 11,000 EMS agencies across 49 states, encompassing 33.4 million patient encounters in 2020, and 19,957 cardiac arrests from overdose. Baseline statistics were taken from the years 2018 and 2019. The results showed that they increased in April 2020 and reached 2,112 cardiac arrests in May, the highest ever recorded. Patient encounters decreased overall by 17.7% between March and April 2020. However, overdose cardiac arrests rose to 78.9 per 100,000 EMS activations in May, which was 98.3% higher than baseline (39.8 per 100,000). Over the course of the year, the rate decreased to 56.7 per 100,000 by December (21.4% above the baseline of 46.7 per 100,000). Additionally, although cardiac arrests were more prevalent in White individuals prior to and during the pandemic, larger increases were observed for Latinx and Black patients in 2020, with increases of 49.7% and 50.3% respectively, compared to an increase of 38.3% in White patients. Those living in impoverished neighbourhoods and Pacific states also experienced large increases (46.4% and 63.8% respectively). In conclusion, there was an enormous increase in overdose-associated cardiac arrests in the United States during the pandemic months of 2020, demonstrating the need for prioritizing overdose prevention measures, especially in communities that experienced larger increases in deaths compared to pre-pandemic era.

Click to read the study in JAMA Psychiatry

Image: PD

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