LAUSR

Study Objective: The COVID-19 pandemic led to profound challenges for health systems and disruptions in care for society’s most vulnerable patients, in particular people with opiate use disorders (OUD). The closure of outpatient addiction clinics, cessation of harm-reduction services, and lack of access to support groups have all been attributed to worsening outcomes for patients with OUD during the COVID-19 pandemic. Most concerningly, emerging evidence points to accelerated rates of overdose deaths. In Los Angeles, a city disproportionately affected by high rates of COVID-19, chronic housing insecurity, and substance use disorder, the Department of Public Health reported a 48% increase in accidental drug overdose deaths during the first five months of the pandemic. In March of 2020, a state of emergency was declared for COVID-19 and stay-at-home orders were issued. These events were associated with a sharp reduction in total ED visits. However, with the profound disruption in usual sources of care and support for people with substance use disorders, emergency departments (EDs) remained a critical access point for these patients. Methods: We examined all visits to public safety-net hospital EDs in Los Angeles County. We considered OUD-related ED visits as those which included any of the following: visits with a discharge diagnosis related to OUD, patients who received buprenorphine or naloxone while in the ED, and visits where a prescription for buprenorphine or naloxone was given on discharge. We performed a logistic regression to examine patient characteristics of opiate use disorder-related visits from April 2019-Feb 2020 compared with April 2020-Feb 2021. Results: Overall, there was a 22% increased odds of an ED visit being related to OUD when we compared pre- and post- COVID shutdown periods in Los Angeles. Visit acuity levels increased across all ESI scores. There was a statistically significant increase in the predicted probability of OUD visits for black and Hispanic patients of 17% and 25% respectively compared to pre-COVID levels. Patients were more likely to present for OUD-related encounters if they were publicly insured, uninsured, or brought in by ambulance. Admitted patients were four times more likely to have an OUD-related ED visit on presentation. Conclusions: Rates of OUD-related ED visits increased during COVID-related shutdowns. These increases were most pronounced among black and Hispanic patients and those with no insurance or publicly funded insurance plans. Patients admitted to the hospital had higher odds of OUD-related complaints. This reinforces the importance of the emergency department as a safety net resource for the most vulnerable patients suffering from OUD during the pandemic and highlights the opportunity to address these disparities with ED-based interventions.