Temporal Patterns of Alcohol- and Drug-Related Overdoses During the COVID-19 Pandemic: A National EMS-Based Study by Age and Gender in Israel.

The COVID-19 pandemic introduced unprecedented societal disruptions that may have altered patterns of acute substance-related harm. Despite extensive research on overdose mortality, there remains limited real-time, population-level evidence based on Emergency Medical Services (EMS) data. This study provides a national, multi-year characterization of temporal trends in alcohol- and drug-related overdose incidents in Israel across thirteen defined pandemic phases. A total of 18,348 overdose cases recorded between 1 January 2019 and 31 December 2022 were analyzed. Descriptive statistics were calculated, event frequencies were normalized by period length, and loglinear Poisson models were applied to compare occurrences across periods. Cluster analysis was used to explore joint age- and gender-related patterns. Alcohol-related overdoses demonstrated marked fluctuations across pandemic phases, whereas drug-related overdoses showed comparatively moderate variation and a gradual increase over time. Age- and gender-specific heterogeneity was observed across periods. As an observational study based on EMS records, causal inference cannot be established. These findings provide population-level surveillance evidence of dynamic overdose patterns during prolonged societal disruption and highlight the importance of integrating EMS-based monitoring into public health preparedness strategies.