Emergency Department Visits, Inpatient Hospitalizations, and Nonfatal and Fatal Drug Overdoses During COVID-19 Among Veterans With Opioid Use Disorder.

Objective: The COVID-19 pandemic had dramatic adverse impacts on people with opioid use disorder (OUD), as evidenced by significant disruptions to care and unprecedented increases in drug overdoses. In this study, we evaluated the impacts of COVID-19 on the use of emergency and inpatient care and fatal and nonfatal overdoses among veterans with OUD.

Method: We used Veterans Health Administration (VHA) electronic medical record and mortality data to compare emergency department visits, inpatient hospitalizations, and fatal and nonfatal overdoses between a pandemic-exposed cohort of veterans with OUD observed both before and after the onset of the pandemic (n = 53,803; observed January 2019 to March 2021) to a matched prepandemic control group (n = 53,803; observed October 2017 to December 2019).

Results: Compared with pre-pandemic trends, there were significant decreases in the odds of emergency department and inpatient admissions and the total number of emergency department and inpatient admissions during COVID-19. There was a significant decrease in the odds of having a recorded nonfatal overdose. The odds of overdose death increased during the pandemic compared with pre-pandemic trends.

Conclusions: We observed significant decreases in the use of emergency department and inpatient care services and fewer nonfatal overdoses after the pandemic's onset. Health care disruptions limiting access to emergency and inpatient care could account for the lower number of recorded nonfatal overdoses, potentially reflecting an underestimate of risk. In contrast, fatal overdoses increased during the pandemic compared with pre-pandemic trends. Lower use of emergency and inpatient care and higher rates of fatal overdoses during the pandemic suggest an exacerbation of unmet treatment needs after the pandemic's onset.