COVID-19 Impact on Australian Patients with Substance Use Disorders: Emergency Department Admissions in Western Sydney before Vaccine Roll Out

Background: In this study, we determined the impact of the COVID-19 pandemic on Western Sydney patients with substance use disorders (SUD) by comparing emergency department (ED) admission rates before and after the onset of the COVID-19 pandemic and before the rollout of COVID-19 vaccination. Methods: ED admission data for patients with SUD were retrieved from the local electronic medical record (eMR) on the hospital central database. ED data collected from 25 January to 25 July 2019 (before the COVID-19 pandemic) were compared with data from 25 January to 25 July 2020 (early pandemic). ED admission reasons were categorised based on the presenting complaints and ED diagnoses. Results: Despite an overall reduction in ED admissions during the early pandemic, compared to the pre-pandemic period, admissions for patients with SUD increased significantly (1.7% to 3.4%, p < 0.01). ED admission rates related to infection (0.05% to 0.12%, p < 0.01), local infection (0.02% to 0.05%, p < 0.01), trauma (0.06% to 0.12%, p < 0.01), alcohol (0.01% to 0.03%, p < 0.05), and other issues (0.06% to 0.10%, p < 0.05) increased significantly among Indigenous patients with SUD. ED admission rates related to drugs (0.12% to 0.39%, p < 0.01), infection (0.21% to 0.34%, p < 0.01), local infection (0.07% to 0.18%, p < 0.01), gastrointestinal (0.15% to 0.23%, p < 0.05), trauma (0.14% to 0.25%, p < 0.01), alcohol (0.36% to 0.74%, p < 0.01), and ‘other’ issues (0.47% to 0.91%, p < 0.01) increased significantly among non-Indigenous patients with SUD. Four cases of COVID-19 were reported among these patients. Conclusions: There was an increase in ED admissions for patients with SUD in the initial six months of the COVID-19 pandemic (before vaccine rollout), mainly for drugs, systemic infection, local infection, trauma, and alcohol-related reasons. Now that most people in New South Wales have been vaccinated against COVID-19, a further study is needed to quantify the effect of the pandemic on patients with SUD in the post-vaccine era.

[1]  P. Dietze,et al.  COVID‐19 vaccine acceptability among people in Australia who inject drugs: Implications for vaccine rollout , 2021, Drug and alcohol review.

[2]  K. Smolina,et al.  Mental Health and Substance Use Associated with Hospitalization among People with COVID-19: A Population-Based Cohort Study , 2021, Viruses.

[3]  Sheikh Mohammed Shariful Islam,et al.  Increased COVID-19 infection risk, COVID-19 vaccine inaccessibility, and unacceptability: Worrisome trio for patients with substance abuse disorders , 2021, Journal of global health.

[4]  D. Taylor,et al.  Relation of substance use disorders to mortality, accident and emergency department attendances, and hospital admissions: A 13-year population-based cohort study in Hong Kong. , 2021, Drug and alcohol dependence.

[5]  C. Chamberlain,et al.  Risk of severe illness from COVID‐19 among Aboriginal and Torres Strait Islander adults: the construct of ‘vulnerable populations’ obscures the root causes of health inequities , 2021, Australian and New Zealand Journal of Public Health.

[6]  M. Coleman,et al.  Responding to rural adversity: a qualitative study of alcohol and other drug service users’ experiences of service response to COVID-19 in Western Australia’s Southwest , 2021, Australasian psychiatry : bulletin of Royal Australian and New Zealand College of Psychiatrists.

[7]  Anthony F Jorm,et al.  Discrimination experienced by Aboriginal and Torres Strait Islander males in Australia: Associations with suicidal thoughts and depressive symptoms , 2021, The Australian and New Zealand journal of psychiatry.

[8]  V. Gruber,et al.  COVID-19 vaccine trust among clients in a sample of California residential substance use treatment programs , 2021, Drug and Alcohol Dependence.

[9]  L. Galea,et al.  The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic , 2021, medRxiv.

[10]  K. Mills,et al.  Substance use, mental disorders and COVID-19: a volatile mix , 2021, Current opinion in psychiatry.

[11]  Christopher M. Jones,et al.  Trends in US Emergency Department Visits for Mental Health, Overdose, and Violence Outcomes Before and During the COVID-19 Pandemic. , 2021, JAMA psychiatry.

[12]  COVID-19 Australia: Epidemiology Report 33: Fortnightly reporting period ending 17 January 2021 , 2021, Communicable Diseases Intelligence.

[13]  anonymous.  COVID-19 Australia: Epidemiology Report 33 Fortnightly reporting period ending 17 January 2021. , 2021, Communicable diseases intelligence.

[14]  M. Potenza,et al.  Trust in a COVID-19 vaccine among people with substance use disorders , 2021, Drug and Alcohol Dependence.

[15]  K. Yazdi,et al.  Impact of the COVID-19 Pandemic on Patients With Alcohol Use Disorder and Associated Risk Factors for Relapse , 2020, Frontiers in Psychiatry.

[16]  J. Levesque,et al.  Impact of COVID-19 on healthcare activity in NSW, Australia. , 2020, Public health research & practice.

[17]  A. Schimmenti,et al.  Facing Loneliness and Anxiety During the COVID-19 Isolation: The Role of Excessive Social Media Use in a Sample of Italian Adults , 2020, Frontiers in Psychiatry.

[18]  K. Yazdi,et al.  Developments in Drug Addiction During COVID-19—An Austrian Perspective Based on a Clinical Sample , 2020, Frontiers in Psychiatry.

[19]  M. Raji,et al.  The Impact of Substance Use Disorder on COVID-19 Outcomes. , 2020, Psychiatric services.

[20]  E. Seto,et al.  Stress, Anxiety, and Change in Alcohol Use During the COVID-19 Pandemic: Findings Among Adult Twin Pairs , 2020, Frontiers in Psychiatry.

[21]  A. Kam,et al.  Fewer presentations to metropolitan emergency departments during the COVID‐19 pandemic , 2020, The Medical journal of Australia.

[22]  N. Volkow,et al.  COVID-19 risk and outcomes in patients with substance use disorders: analyses from electronic health records in the United States , 2020, Molecular Psychiatry.

[23]  G. Martinotti,et al.  Psychopathological Burden and Quality of Life in Substance Users During the COVID-19 Lockdown Period in Italy , 2020, Frontiers in Psychiatry.

[24]  G. D’Onofrio,et al.  Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US , 2020, JAMA internal medicine.

[25]  B. Marshall,et al.  Drug use during a pandemic: Convergent risk of novel coronavirus and invasive bacterial and viral infections among people who use drugs , 2020, International Journal of Drug Policy.

[26]  Jessica L. Willis.  Closing the gap - 2020 marks a new era , 2020 .

[27]  Subhankar Chatterjee,et al.  Psychosocial impact of COVID-19 , 2020, Diabetes & Metabolic Syndrome: Clinical Research & Reviews.

[28]  J. Mackolil,et al.  Addressing psychosocial problems associated with the COVID-19 lockdown , 2020, Asian Journal of Psychiatry.

[29]  P. Haber,et al.  Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic , 2020, Harm Reduction Journal.

[30]  T. Green,et al.  An overdose surge will compound the COVID-19 pandemic if urgent action is not taken , 2020, Nature Medicine.

[31]  T. Clausen,et al.  COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper , 2020, Basic and clinical neuroscience.

[32]  C. Hassan,et al.  Endoscopy Units and the Coronavirus Disease 2019 Outbreak: A Multicenter Experience From Italy , 2020, Gastroenterology.

[33]  K. Humphreys,et al.  Mitigating and learning from the impact of COVID-19 infection on addictive disorders. , 2020, Addiction.

[34]  G. Alexander,et al.  An Epidemic in the Midst of a Pandemic: Opioid Use Disorder and COVID-19 , 2020, Annals of Internal Medicine.

[35]  Liz J Walker.  2019-nCoV acute respiratory disease, Australia - Epidemiology Report 1 (Reporting week 26 January – 1 February 2020) , 2020 .

[36]  T. Rummans,et al.  Infectious diseases occurring in the context of substance use disorders: A concise review , 2020, Journal of the Neurological Sciences.

[37]  J. Weiner,et al.  Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study. , 2020, Annals of emergency medicine.

[38]  Aaron W. Cashmore,et al.  Can a continuous quality improvement program create culturally safe emergency departments for Aboriginal people in Australia? A multiple baseline study , 2019, BMC Health Services Research.

[39]  C. Holland.  Close the gap 2018 - a ten year review: the Closing the Gap strategy and recommendations for reset , 2018 .

[40]  M. Lincoln,et al.  Improving the efficacy of healthcare services for Aboriginal Australians. , 2018, Australian health review : a publication of the Australian Hospital Association.

[41]  D. Satre,et al.  Alcohol, Marijuana, and Opioid use Disorders: 5-Year Patterns and Characteristics of Emergency Department Encounters , 2018, Substance abuse.

[42]  A. Boyle,et al.  Emergency department-based interventions for women suffering domestic abuse: a critical literature review , 2017, European journal of emergency medicine : official journal of the European Society for Emergency Medicine.

[43]  S. Irving,et al.  Preventing intimate partner violence across the lifespan : a technical package of programs, policies, and practices , 2017 .

[44]  A. Crosby,et al.  Preventing suicide : a technical package of policies, programs, and practice , 2017 .

[45]  A. Lyons,et al.  Opioid Substitution Treatment Planning in a Disaster Context: Perspectives from Emergency Management and Health Professionals in Aotearoa/New Zealand , 2016, International journal of environmental research and public health.

[46]  J. Poorolajal,et al.  Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. , 2016, Journal of public health.

[47]  C. Runyan,et al.  Lethal Means Counseling for Parents of Youth Seeking Emergency Care for Suicidality , 2016, The western journal of emergency medicine.

[48]  F. Vaca,et al.  Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies , 2015, The Yale journal of biology and medicine.

[49]  K. Carrington,et al.  Domestic violence (DV) service provision and the architecture of rural life: An Australian case study , 2015 .

[50]  N. Drew,et al.  Overview of Aboriginal and Torres Strait Islander health status, 2015 , 2015 .

[51]  Steven A R Webb,et al.  Accuracy of International classification of diseases, 10th revision codes for identifying severe sepsis in patients admitted from the emergency department. , 2012, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[52]  N. Thomson.  Australian Indigenous HealthInfoNet , 2005 .

[53]  E. Englev,et al.  [ICH-GCP Guideline: quality assurance of clinical trials. Status and perspectives]. , 2003, Ugeskrift for laeger.