EMS Encounters for Youth Opioid Overdoses Remain Higher Than Before the Pandemic

Emergency medical services (EMS) encounters for youth opioid overdoses were rising before the COVID-19 pandemic, increased during its onset, and then flattened out, but remained higher than prepandemic levels, a cross-sectional study of nationwide data showed.

Prepandemic EMS encounters with youths who overdosed on opioids significantly increased by 29.9 per month (95% CI 9.3-50.4), with 810 and 1,538 encounters in January 2018 and February 2020, respectively, reported Jamie Lim, MD, of the Ann & Robert H. Lurie Children’s Hospital of Chicago, and co-authors in a research letter in JAMA.

The interruption triggered by the pandemic was tied to “an immediate and significant increase” in overdose encounters, and a subsequent change in trend (P=0.008) from significantly increasing to not significantly changing (-11.1 per month, 95% CI -27.1 to 4.9), with monthly encounters remaining higher than prepandemic levels (1,824 and 1,503 encounters in April 2020 and December 2022, respectively).

These trends were mainly driven by increases in overdoses among youths ages 18 to 24, Lim and team noted.

Adolescents ages 12 to 17 were the only age group with a significantly increasing trend in opioid overdoses both before the pandemic (2.8 per month, 95% CI 1.4-4.2) and during the pandemic (1.6 per month, 95% CI 0.5-2.6), which Lim suggested was cause for alarm.

“I think we need to pay attention to this adolescent group … that is seemingly overdosing more and more,” Lim told MedPage Today, noting that research has shown that opioid overdose deaths among adolescents have been increasing at a faster rate than the general population for several years.

Kao-Ping Chua, MD, PhD, of the University of Michigan in Ann Arbor, told MedPage Today that it’s likely many of the youths in this study did not die.

“Thus, the findings indirectly suggest that nonfatal opioid overdoses also rose among youth during the pandemic,” he said.

Lim pointed out that EMS workers don’t always know patient outcomes, which makes teasing out mortality data difficult.

Both Chua and Lim said that many young people are unknowingly exposed to fentanyl while experimenting with drugs and don’t have a previous opioid use disorder before overdosing.

“Clinicians and educators must ensure that young people understand the increasing risks of substance use and encourage abstinence,” Chua stressed.

In the study, most opioid overdose encounters were for those ages 18 to 24 (86.7%), among males (65.1%), occurred at a private residence (58.3%), and had at least one dose of naloxone (Narcan) administered by EMS personnel (66.3%). Less than 1% of encounters occurred in recreational facilities or schools. Of note, 88.3% of encounters occurred in urban neighborhoods, and roughly half involved youths who ranked “low” or “very low” on the Childhood Opportunity Index, a neighborhood-based measure of education, health and environment, and social and economic conditions.

The authors noted that prehospital data can “be valuable for understanding specific nuances about youth drug overdoses.”

“For example, plateauing levels of youth overdoses after the initial increase may reflect easing of pandemic-related stressors or public health efforts, although monitoring is necessary to determine if levels return to prepandemic levels,” they wrote. “Moreover, prehospital data provide overdose location context that can inform targeted prevention strategies, such as increasing naloxone in homes, and offer insights into prehospital overdose management, such as naloxone administration prior to hospital arrival.”

For this study, Lim and colleagues used data from the National EMS Information System on EMS encounters for youths ages 24 and younger from 2018 through 2022 with either an ICD-10 code for opioid-related overdose or a positive response to naloxone administration.

They also used descriptive statistics to characterize encounters for youth opioid overdoses by age group, sex, the Child Opportunity Index, census division, location, urbanicity, naloxone doses administered, disposition, and level of care.

Study limitations included potential changes in coverage by EMS agencies, as well as unlinked encounters, the omission of race and ethnicity data, and the omission of mortality outcomes due to missing and uncertain quality of data, the authors noted.

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