Clinical outcomes of admitted patients with COVID and an opioid overdose

To date, research on opioid overdose during the COVID-19 pandemic has focused on rates of Emergency Department (ED) visits related to opioids but has not considered how interaction with concurrent COVID-19 infection may have influenced clinical outcomes. We hypothesized that COVID-19 infection increased the need for respiratory support, prolonged hospital stays, and increased mortality among ED patients admitted to the hospital after presenting with opioid overdose.

The 2020 National Emergency Department Sample (NEDS) was used to identify patients admitted to the hospital after presenting to the ED with opioid overdose, and whose COVID-19 infection status could be determined. The primary outcome was the use of respiratory support, and secondary outcomes were hospital length of stay (LOS) and mortality.

Among the 5913 eligible patients, 3 % had a COVID-19 infection diagnosis. Among all included patients, 28 % received respiratory support, in-hospital mortality was 4 %, and the mean hospital length of stay was 3.9 days. After multivariable adjustment, COVID-19 was not associated with the use of respiratory support (odds ratio [OR]: 0.98; 95 % confidence interval [CI]: 0.67, 1.44; p = 0.938). COVID-19 was associated with higher odds of in-hospital mortality (OR: 2.22; 95 % CI: 1.20, 4.11; p = 0.011) and longer hospital stay (incidence rate ratio: 1.57, 95 % CI: 1.22, 2.01; p < 0.001).

This data suggests that COVID-19 infection in patients admitted to the hospital with opioid overdose results in higher morbidity and longer hospital stay, but had no association with the use of respiratory support. The physiologic cause deserves future study.