Opioid Overdose Hospitalizations During COVID-19: The Experience of Pennsylvania

Chan Shen; James Douglas Thornton; Ning Li; Shouhao Zhou; Li Wang; Douglas L Leslie; Sarah S Kawasaki

doi:10.1177/11782218231222343

Opioid Overdose Hospitalizations During COVID-19: The Experience of Pennsylvania

Subst Use. 2024 Jan 10:18:11782218231222343. doi: 10.1177/11782218231222343. eCollection 2024 Jan-Dec.

Authors

Chan Shen^{1

2}, James Douglas Thornton³, Ning Li⁴, Shouhao Zhou², Li Wang², Douglas L Leslie², Sarah S Kawasaki⁵

Affiliations

¹ Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
² Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
³ Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.
⁴ Department of Economics and Finance, Salisbury University, Salisbury, MD, USA.
⁵ Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA.

Abstract

Objective: The COVID-19 pandemic placed extreme burden on hospitals, while opioid overdose is another challenging public health issue. This study aimed to examine the trends and outcomes of opioid overdose hospitalizations in Pennsylvania during 2018 to 2021.

Design: We identified opioid overdose hospitalizations in the state of Pennsylvania using the state-wide hospital discharge database (PHC4) 2018 to 2021. We examined the number of opioid overdose hospitalizations, the corresponding mortality and discharges against medical advice comparing the pre-COVID period (2018-2019) and the COVID period (2020-2021). We also assessed what patient and hospital characteristics were associated with in-hospital death or leaving against medical advice.

Results: A total of 13 446 opioid-related hospitalizations were identified in 2018 to 2021. Compared to pre-pandemic, a higher percentage of cases involving synthetics (17.0%vs 10.3%, P < .0001) were observed during COVID. After controlling for covariates, there was no significant difference in opioid overdose in-hospital deaths in the years 2020 to 2021 compared to 2018 to 2019 (OR = 0.846, 95% CI: 0.71-1.01, P = .065). The COVID period was significantly associated with more leaving against medical advice compared to years 2018 to 2019 (OR = 1.265, 95% CI: 1.11-1.44, P = .0003). Compared to commercial insurance, Medicaid insurance was associated with higher odds of both in-hospital death (OR = 1.383, 95% CI: 1.06-1.81, P = .0176) and leaving against medical advice (OR = 1.903, 95% CI: 1.56-2.33, P < .0001).

Conclusion: There were no substantial changes in the number of overall opioid overdose cases and deaths at hospitals following the outbreak of COVID-19 in Pennsylvania. This observation suggests that an increased number of patients may have succumbed to overdoses outside of hospital settings, possibly due to a higher severity of overdoses. Further, we found that patients were more likely to leave against medical advice during the COVID-19 pandemic.

Keywords: COVID-19; Opioid overdose; hospitalization.

Abstract

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