ArticleThe western journal of emergency medicine2026
Opioid Overdose-Related Emergency Department Visits Pre- and Post-COVID-19.
Article in The western journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionUnderstanding changes in opioid overdose-related emergency department (ED) visits and ED-based opioid use disorder (OUD) treatment post-coronavirus disease 2019 (COVID-19) pandemic can inform ongoing efforts to address the opioid crisis. We aimed to examine trends in opioid overdose-related ED visits, ED-based medication for OUD (MOUD) treatment, and appendicitis-related ED visits (as a control) before and after the initial COVID-19 peak in April 2020.
methodsWe conducted an interrupted time series analysis of monthly ED visits from January 2017-December 2022 at three hospitals in California. We modeled pre- and post-COVID-19 visit trends and the change in trend from pre- to post-COVID-19 peak using linear regression controlling for study site. Our primary outcome included monthly rates of opioid overdose-related ED visits, with monthly rates of ED visits with MOUD treatment as a secondary outcome. Appendicitis-related visits served as a control for temporal trends.
resultsOf the 781,488 ED visits across the entire study period, there were 2,536 (0.32%) opioid overdose-related visits, 9,755 (1.25%) MOUD treatment visits, and 1,123 (0.14%) appendicitis-related visits. Pre-pandemic, monthly increases were observed in opioid overdose-related visits (6.7 visits/10,000 per month, 95% confidence interval [CI] 2.6-10.8, P = .001), MOUD-positive visits (34.9 visits/10,000 per month, 95% CI, 26.0-43.7, P < .001), and appendicitis visits (2.5 visits/10,000 per month, 95% CI, 1.2-3.9, P < .001). After April 2020, only MOUD-positive visits showed an immediate (level change) increase (49 visits/10,000 or 34% of April 2020 projected pre-COVID-19 visit rates, 95% CI, 26.1-71.9, P < .001), with opioid overdose-related visits subsequently declining (-4.6 visits/10,000 per month or -11% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -2.0, P = .001). Across the entire pre- to post-COVID-19 period, significant decreases in overall visit trends were observed across all visit types, greatest for MOUD-positive visits (-39.2 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -51.5 to -26.8, P < .001), followed by opioid overdose visits (-11.3 visits/10,000 per month, or -27% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -16.1 to -6.5, P < .001) and appendicitis visits (-4.2 visits/10,000 per month, or -23% of April 2020 projected pre-COVID-19 visit rates, 95% CI, -7.2 to -1.2, P = .01).
conclusionFrom pre- to post-initial COVID-19 peak, absolute ED-based MOUD treatment trends declined over three times faster than those of opioid overdose-related ED visits (although percentage changes relative to expected April 2020 rates were both -27%). These findings may reflect reduced perceived urgency as overdose presentations decreased and a shift away from crisis-driven implementation, underscoring the need for intentional integration of MOUD into routine ED practice to sustain treatment capacity.
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