Overdose calls slum EMS in a pandemic

Analysis of national Emergency Medical Services (EMS) data shows a surge in cardiac arrest associated with overdose during a pandemic.

Between January 1st and August 1st, 2020, overdose-related cardiac arrest accounted for 49.5 for every 100,000 activations of EMS, with weekly averages of 2018 and 2019 values. Compared to that, it increased by 48.5%, reports college medical student Joseph Friedman MPH. University of California, Los Angeles, and colleagues.

In an online study, the team said cardiac arrest, which is usually associated with fatal overdose, began to increase in mid-March and increased by 74.1 per 100,000 EMS calls in April, or 123.4% from baseline. I will. JAMA Psychiatry..

“There are challenges in overdose studies with long delays associated with traditional database sources such as state-level mortality databases,” Friedman said. Today’s MedPage. “We were now looking for a way to monitor this. EMS data is available in real time.”

As of October 31, 2020, all but nine states in the United States have reported Increased opioid-related mortality, According to the American Medical Association.To Provisional CDC data, The total number of deaths from overdose recorded between January and March of this year was 19,416, almost 3,000 more than in the same quarter last year.

Luis S. Nelson, MD, MD, Newark’s Ratgers New Jersey Medical College, said before the pandemic, primarily due to an increase in fentanyl circulating in drug supply, despite a slight reduction in deaths from overdose that occurred a few years ago. Commented that deaths from overdose were increasing. , Those who were not involved in the study.

“These numbers far exceed any trends seen in the last decade,” he said. Today’s MedPage. “They are very astounding and annoying.”

The pandemic may have disrupted the supply of narcotics to some patients, causing overdose by consuming drugs containing traces of fentanyl or other substances, Friedman said, psychologically and economically of the pandemic. More often substances added that a pandemic may also be driving people to use.

“There were many reasons to believe that COVID-19 could exacerbate case fatality from overdose. [including] “Most of the population is becoming more and more difficult to live, including increased social isolation,” Friedman said.

Nelson says that increased social isolation can promote increased overdose when people are using the drug alone in the absence of anyone calling EMS or administering naloxone. I agreed.

In this study, researchers showed a correlation between overdose mortality and social mobility measured from mobile phone data, with a sharp decline in fluidity starting March 16 and April. By 13th, it was 51.8% below baseline and by 27th July, it was 24.3% below baseline.

Dr. Richard A. Jorgensen, MD, Coroner, DuPage County, Wheaton, Illinois, said Today’s MedPage This study was consistent with the increase in overdose mortality he observed in his area. Overdose for the first 6 months of 2020 The number of deaths increased by 52% year-on-year It was 22 in the last two weeks of April and the first week of May alone. For comparison, Jorgensen said there were 38 deaths from overdose throughout 2012. This is the first year as a coroner in a county of about 920,000 people.

When considering deaths from overdose, he found that all deaths were related to people with a history of mental illness who lived alone and had financial or personal problems managing with addiction. I found that there is.

“It became clear that these are people [for whom] The shelters are destroying them mentally, “Jorgensen said... “When you think of successful rehabilitation programs, virtually every program relies on social support.”

The Substance Abuse and Mental Health Services Department has relaxed prescribing restrictions on drug therapy during pandemics, Many patients still struggle to access processing.

A new study suggests that all calls related to overdose have been stable throughout the pandemic month, suggesting that “somewhat successful in implementing telemedicine and liberalizing buprenorphine prescribing and naloxone administration.” He said. These policy changes may explain the increase in overdose.

Other countries are implementing more liberal harm reduction strategies to reduce deaths from overdose. For example, Portugal, once the capital of European heroin, Decriminalized drug use, Direct funds from enforcement to public health prevention and rehabilitation services.

Proponents of legalization and implementation measures, such as safe injection sites, argue that a cleaner drug supply makes drug users less likely to overdose from substances like fentanyl. However, both practices are controversial.

“We know that the war on drugs is a failed endeavor, but that doesn’t mean it’s good to legalize the use of these drugs,” Nelson said. “Like a safe injection site, it will be very difficult to do.”