During the covid-19 pandemic Emergency Department (ED) visits for unrelated illnesses plummeted across the United States. Yet concern exists that some conditions may have been exacerbated during the pandemic. One such condition is substance use disorders, so researchers at Virginia Commonwealth University analyzed data from patients with a diagnosis of unintentional nonfatal opioid overdose between March 1, 2020 and June 30, 2020 compared to the same time period in 2019. Their paper appears in JAMA as a research letter. Their analysis found twice as many visits for nonfatal opioid overdoses in 2020. However, during this time period there were over 10,000 fewer total ED visits. That said, a recent report issued by the CDC showed that overdoses were already markedly increased in January of 2020, suggesting that complications from opioid use disorder were already on the rise prior to the appearance of covid-19. 

In this present study, patients who were Black were disproportionately affected and accounted for 80 percent of the visits in 2020, an increase from 63 percent in 2019. This study also highlighted room for growth in treatment of patients with opioid use disorder, as only 56 percent of patients received a naloxone prescription at discharge, a powerful antidote that saves many lives and is widely available. 56 percent could be an underestimate, however, as there is a "standing order" at pharmacies for outpatient naloxone in Virginia—meaning that a prescription is not required in each instance; the drug is, in effect, available on-demand. Reassuringly, more patients received opioid use disorder treatment resources or referrals in 2020 (68 percent versus 44 percent in 2019). More patients also attended outpatient opioid treatment programs (10 percent in 2020 versus 3 percent in 2019). 

While it is encouraging that the proportion of patients receiving referrals or attending outpatient opioid treatment increased from 2019 to 2020, the numbers are still discouraging overall. This study highlights the need for emergency clinicians, communities and healthcare systems to aggressively promote harm reduction strategies and engage appropriate patients in medication for opioid use disorder. It is also just one way we have learned that covid-19 has kept our patients away from the ED with untreated illnesses. Whether that has contributed to any statistical increase in deaths nationwide remains unclear and unproven. 

The Lancet, one of the most prestigious medical journals in the world, recently released a review of policies associated with the easing of lockdown measures in nine high-income areas across Asia and Europe to establish any trends that may help with future decision-making. The analysis boils down to five key recommendations. The authors stress while there is no one-size-fits-all plan, these points should factor into any discussions by policymakers.

1. Transparency: a clear-cut timeline with defined levels and stages of lockdown needs to be readily available, as well as criteria for moving between levels. 
2. Robust data collection: governments need to be able to quickly and accurately assess current caseload when making determinations regarding changes to safety measures.
3. Persistent control measures: policies to prevent spread, including use of social distancing and personal protective equipment will need to be in place for an extended period of time after reducing restrictions to prevent case resurgence.
4. Effective testing systems: a robust ability to screen, trace, isolate and support new cases must be established beforehand. Further, these measures need persistent investments in public health institutions to ensure their continued, effective use.
5. Zero transmission strategy: countries should consider the New Zealand model, aimed at eliminating all domestic transmissions.

The authors note that many of these strategies have been adopted to one extent or another in different countries, with cultural beliefs and government preparedness playing large roles in their respective successes and failures.  The Lancet.