Drug Overdoses During the COVID-19 Pandemic Among Recently Homeless Individuals

Michael Liu; Lucie Richard; Michael A Campitelli; Rosane Nisenbaum; Naheed Dosani; Irfan A Dhalla; Rishi K Wadhera; Salimah Z Shariff; Stephen W Hwang

doi:10.1111/add.15823

Drug Overdoses During the COVID-19 Pandemic Among Recently Homeless Individuals

Addiction. 2022 Jun;117(6):1692-1701. doi: 10.1111/add.15823. Epub 2022 Feb 14.

Authors

Michael Liu^{1

2

3}, Lucie Richard⁴, Michael A Campitelli³, Rosane Nisenbaum^{2

5}, Naheed Dosani⁶, Irfan A Dhalla^{7

8}, Rishi K Wadhera⁹, Salimah Z Shariff⁴, Stephen W Hwang^{2

7

8}

Affiliations

¹ Harvard Medical School, Boston, MA, USA.
² MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.
³ ICES Central, Toronto, Canada.
⁴ ICES Western, London, Canada.
⁵ Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁶ Division of Palliative Care, McMaster University, Hamilton, Canada.
⁷ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁸ Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
⁹ Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

Aims: To examine how weekly rates of emergency department (ED) visits for drug overdoses changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the pre-pandemic, peak, and re-opening periods of the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control.

Design: Population-based retrospective cohort study conducted between September 30, 2018 and September 26, 2020.

Setting: Ontario, Canada.

Participants: A total of 38 617 IRHH, 15 022 369 housed individuals, and 186 858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden.

Measurements: ED visits for drug overdoses of accidental and undetermined intent.

Findings: Average rates of ED visits for drug overdoses between January and September 2020 were higher among IRHH compared with housed individuals (rate ratio [RR], 148.0; 95% CI, 142.7-153.5) and matched housed individuals (RR, 22.3; 95% CI, 20.7-24.0). ED visits for drug overdoses decreased across all groups by ~20% during the peak period (March 17 to June 16, 2020) compared with corresponding weeks in 2019. During the re-opening period (June 17 to September 26, 2020), rates of ED visits for drug overdoses were significantly higher among IRHH (RR, 1.56; 95% CI, 1.44-1.69), matched housed individuals (RR, 1.25; 95% CI, 1.08-1.46), and housed individuals relative to equivalent weeks in 2019 (RR, 1.07; 95% CI, 1.02-1.11). The relative increase in drug overdose ED visits among IRHH was larger compared with both matched housed individuals (P = 0.01 for interaction between group and year) and housed individuals (P < 0.001) during this period.

Conclusions: Recently homeless individuals in Ontario, Canada experienced disproportionate increases in ED visits for drug overdoses during the re-opening period of the COVID-19 pandemic compared with housed people.

Keywords: COVID-19; cohort studies; drug overdose; emergency department visits; homeless persons; vulnerable populations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Drug Overdose* / epidemiology
Emergency Service, Hospital
Humans
Ill-Housed Persons*
Ontario / epidemiology
Pandemics
Retrospective Studies