(B-291) Opioid-related Emergency Department Visits: An Interrupted Time Series Analysis of Visits Patterns Pre, and Post COVID-19 Lockdown

Background: Studies have shown that lockdowns related to COVID-19 have been associated with increased rates of opioid and psychotropic related emergency department (ED) visits. Whether COVID-19 lockdowns have had a similar impact in Saudi Arabia remains unknown.

Objectives: To analyze patterns of ED visits related to opioids and psychotropics use disorders before and after COVID-19 lockdown in a Saudi population.

Methods: This study employed an interrupted time series analysis. Data from the Saudi Real-World Evidence Network (SRWEN) and the Ministry of Health’s Online Toxicology Analysis Request and Result (OTAAR) platform, were used to construct the times series. Adults (≥18 years old) with ED visits related to opioids or psychotropics, from 2018 – 2022, who had a positive toxicology test, or had use of medications (naloxone, flumazenil) were included in the study. The impact of the lockdown, period March 2020 to June 2020, on rates of opioids and psychotropics related ER visits was analyzed using the ARIMA. Sensitivity analyses were conducted to assess the robustness of the findings. All analyses were conducted using RStudio 1.4.553.

Results: Between February 2018 and April 2022, the Saudi Real-World Evidence Network (SRWEN) recorded a total of 3,820 (88%) opioid-related and 536 (12%) psychotropic-related emergency department visits. According to data from the Online Toxicology Analysis Request and Result (OTAAR) platform, positive toxicology tests accounted for 769 (9%) opioid cases and 5,326 (57%) psychotropic cases. The ARIMA model for opioid-related ED visits using the SRWEN data revealed an immediate increase (pulse effect) in the rate by 14.75 (95% CI: 9.65 to 19.86) representing an acute response to the COVID-19 lockdown, and a slope change of -0.6 opioid-related ED visits per month (95% CI: -0.08 to -0.03). However, OTAAR data revealed no significant changes in pulse or slop.

Conclusions: We found that COVID-19 lockdown was associated with an abrupt increase in opioid-related ER visits followed by a steep decrease in the pattern. This study findings support policies aimed at mitigating opioid- and psychotropic-related misuse during public health emergencies and serve as a baseline for researchers to further investigation of these patterns.