Real-Time Data Shows Opioid Overdoses Increased During Pandemic

Using a real-time data monitoring tool, researchers from Michigan Medicine discovered a 15 percent rise in suspected opioid overdose deaths since the early weeks of the COVID-19 pandemic.

The tool also showed a 29 percent rise in first responders’ use of naloxone, a drug that can reverse an opioid overdose if given in time. Deaths started to increase soon after the virus began spreading in Michigan, while naloxone use decreased before rising in the spring and summer.

Developed in partnership with the Michigan HIDTA, a federal program that tracks drug trafficking, the real-time data system gathers information from EMS agencies and medical examiners across most of Michigan.

The System for Opioid Overdose Surveillance (SOS) presents data down to an approximate location in a secure dashboard that first responders and public health authorities can use to target opioid prevention and response efforts.

The SOS made critical data available in a timely way, with daily updates from most sources. The system has also revealed some significant associations between the current health crisis and the ongoing opioid epidemic.

“While we don’t have a cause-and-effect explanation for what we’re seeing, we know that in the first few months after the pandemic arrived in Michigan, many people were avoiding emergency departments unless they had severe symptoms of COVID-19,” said IPC director Patrick Carter, MD, an emergency medicine physician at Michigan Medicine, U-M’s academic medical center.

The pandemic could have an indirect influence on the increasing numbers of opioid-related fatalities.

“The increase in opioid-related fatalities during those initial months appears to fit this pattern,” Carter stated.

“The isolation and stress of the pandemic, the loss of jobs and therefore insurance that might cover substance abuse treatment, and even changes in how people have gathered during these months may all play a role in how people are using opioids, including relapsing during recovery. Efforts to distribute naloxone and engage in peer counseling also decreased during the early months of the pandemic, as public health agencies focused on the virus.”

The SOS tool showed that early in 2020, between 30 and 40 Michigan residents died of a suspected overdose each week. However, when coronavirus surged during mid-March, that number topped 40 a week and kept rising through early June. The number didn’t fall to the figures seen in the early weeks of 2020 until late August.

Although there was also a rise in overdose deaths in the warmer months of the year, the average peaked at around 40 a week that year.

A similar trend emerged when researchers examined the use of naloxone. The number of emergency responders using naloxone started the year at around 250 per week. But it started rising steadily in mid-March, and peaked in early August at around 400 a week on average.

In 2019, warmer months also showed a rise in the use of naloxone, but the number of naloxone uses peaked at around 275 a week on average.

The researchers also found that from March to mid-September, the counties hit hardest by COVID-19 during the spring surge also had the largest relative increases in overdose deaths.

The SOS tool has helped public health officials guide interventions and prevention efforts.

“The SOS team was intentional about engaging Detroit community-based organizations in the design of the platform; to me, this demonstrates their belief in the practice of data justice, because they sought to understand the lived experiences, barriers and assets of the communities being studied, in order to create a tool that is responsive to residents and neighborhood organizations leading action to address the opioid crisis,” said Adaora Ezike, MHS, the Trauma & Behavioral Health Manager in the Detroit Health Department’s Behavioral Health Division. 

“We also utilize demographic data from SOS reports to develop and vet culturally-informed overdose prevention messaging for our public education campaign.”

The SOS team has received additional funding from the federal Substance Abuse and Mental Health Services Administration and the CDC to help more agencies contribute to the dashboard and use it in their work. Researchers will also publish a description of how they built the tool to help other states and regions copy the approach.

The SOS dashboard is believed to be the first in the country to include real-time naloxone administration and suspected overdose death data, without additional action needed from agencies beyond their usual reporting. Understanding trends in opioid deaths in comparison to the spread of COVID-19 can help officials develop location-specific interventions.

“The more we can help agencies micro-target and prioritize their efforts during the pandemic, when it’s harder to get resources to people and public health agencies are stretched, the better,” said Carter, who is also a member of the U-M Institute for Healthcare Policy and Innovation.