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Opioids

Racial/Ethnic Disparities in Unintentional Fatal and Nonfatal Emergency Medical Services–Attended Opioid Overdoses During the COVID-19 Pandemic in Philadelphia

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: January 21, 2021

Research Letter

Article Information and Disclosures

Utsha G. Khatri, MD^1,2;

Lia N. Pizzicato, MPH³;

Kendra Viner, PhD, MPH³;

Emily Bobyock, MPH⁴;

Monica Sun, MPH³;

Zachary F. Meisel, MD, MPH, MSHP⁵;

Eugenia C. South, MD, MSHP⁶

Author Affiliations

¹National Clinician Scholars Program, Corporal Michael J. Crescenz Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia
²Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
³Substance Use Prevention and Harm Reduction Division, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
⁴Philadelphia Fire Department Emergency Medical Services, Philadelphia, Pennsylvania
⁵Center for Emergency Care Research and Policy, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
⁶Urban Health Lab, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia

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Opioid overdoses have increased during the coronavirus disease 2019 (COVID-19) pandemic.¹ Potential contributors include treatment center closures, physical isolation preventing bystander rescue, mental health stressors, financial instability, and changes to drug supply networks.² Black individuals with opioid use disorder (OUD) may be disproportionately affected, given the racial disparities in COVID-19 morbidity and mortality.³ We describe the differential associations of the COVID-19 pandemic with overdoses among racial/ethnic groups in Philadelphia, Pennsylvania.

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Article Information

Accepted for Publication: December 4, 2020.

Published: January 21, 2021. doi:10.1001/jamanetworkopen.2020.34878

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Khatri UG et al. JAMA Network Open.

Corresponding Author: Utsha G. Khatri, MD, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall, 13th Floor, Philadelphia, PA 19104 (utsha.khatri@pennmedicine.upenn.edu).

Author Contributions: Drs Khatri and Pizzicato had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Khatri, Pizzicato, Viner.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Khatri.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Khatri, Viner.

Obtained funding: Viner.

Administrative, technical, or material support: Khatri, Pizzicato, Viner, Meisel.

Supervision: South.

Conflict of Interest Disclosures: Dr Khatri reported receiving fellowship funding from the Department of Veterans Affairs. Dr Bobyock reported receiving grants from the Substance Abuse and Mental Health Services Administration during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded in part by grant R01CE003143 to Drs South and Meisel from the US Centers for Diseases Control and Prevention and grant 76233 to Dr South from the Robert Wood Johnson Foundation Harold Amos Medical Faculty Development Program.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The contents of this article do not represent the views of the US Department of Veterans Affairs or the US government.

References

Slavova S , Rock P , Bush HM , Quesinberry D , Walsh SL . Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend. 2020;214:108176. doi:10.1016/j.drugalcdep.2020.108176 PubMed Google Scholar

Wang QQ , Kaelber DC , Xu R , Volkow ND . COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States. Mol Psychiatry. 2020. doi:10.1038/s41380-020-00880-7 PubMed Google Scholar

Millett GA , Jones AT , Benkeser D , et al. Assessing differential impacts of COVID-19 on black communities. Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003 PubMed Google Scholar Crossref

American Medical Association. Issue brief: reports of increases in opioid- and other drug-related overdose and other concerns during COVID pandemic. Updated December 9, 2020. Accessed December 11, 2020. https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf

Goedel WC , Shapiro A , Cerdá M , Tsai JW , Hadland SE , Marshall BDL . Association of racial/ethnic segregation with treatment capacity for opioid use disorder in counties in the United States. JAMA Netw Open. 2020;3(4):e203711. doi:10.1001/jamanetworkopen.2020.3711 PubMed Google Scholar

Khatri UG , Viner K , Perrone J . Lethal fentanyl and cocaine intoxication. N Engl J Med. 2018;379(18):1782-1782. doi:10.1056/NEJMc1809521 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.