Telehealth and the opioid crisis during COVID-19: urban-rural disparities in emergency care and poison center teleconsultations

Christopher R Schanbacher; Eliezer Santos Leon; Sydney Krispin; Daniel J McCabe; J Priyanka Vakkalanka

doi:10.1080/15563650.2025.2603516

Although the full impact of the COVID-19 pandemic on opioid overdose management across urban and rural settings may take years to fully elucidate, poison center teleconsultations provide valuable early indicators of emerging clinical patterns. We examined the epidemiological and clinical effects of the pandemic on teleconsultations involving intentional opioid exposures from United States poison centers.INTRODUCTIONAlthough the full impact of the COVID-19 pandemic on opioid overdose management across urban and rural settings may take years to fully elucidate, poison center teleconsultations provide valuable early indicators of emerging clinical patterns. We examined the epidemiological and clinical effects of the pandemic on teleconsultations involving intentional opioid exposures from United States poison centers.We conducted a quasi-experimental study (2018-2022) of intentional opioid overdoses reported to United States poison centers. Through multivariable multinomial and logistic regression, we assessed the relationships between time (pre-COVID-19 versus after COVID-19 onset) and geography (urban or rural) with change in the following outcomes: opioid cases; clinical disposition (admission to a critical care unit, non-critical care unit, psychiatric admission); and clinical management (naloxone, endotracheal intubation).METHODSWe conducted a quasi-experimental study (2018-2022) of intentional opioid overdoses reported to United States poison centers. Through multivariable multinomial and logistic regression, we assessed the relationships between time (pre-COVID-19 versus after COVID-19 onset) and geography (urban or rural) with change in the following outcomes: opioid cases; clinical disposition (admission to a critical care unit, non-critical care unit, psychiatric admission); and clinical management (naloxone, endotracheal intubation).While there was only a 1% (mean difference 0.8%; 95% CI: 0.7-0.8) increase in the proportion of opioid overdoses, trends and clinical management were different compared to pre-COVID-19 urban cases. Admission to critical care units declined during the COVID-19 era for both urban (adjusted odds ratio: 0.59; 95% CI: 0.56-0.63) and rural (adjusted odds ratio: 0.67; 95% CI: 0.61-0.74) patients. Naloxone administration decreased during the pandemic in both urban (adjusted odds ratio: 0.69; 95% CI: 0.65-0.72) and rural (adjusted odds ratio: 0.84; 95% CI: 0.77-0.92) settings. Endotracheal intubation rates were lower in rural (adjusted odds ratio: 0.74; 95% CI: 0.62-0.88) and urban (adjusted odds ratio: 0.67; 95% CI: 0.61-0.74) settings during COVID-19, with rural patients consistently showing lower odds compared to pre-COVID urban patients.RESULTSWhile there was only a 1% (mean difference 0.8%; 95% CI: 0.7-0.8) increase in the proportion of opioid overdoses, trends and clinical management were different compared to pre-COVID-19 urban cases. Admission to critical care units declined during the COVID-19 era for both urban (adjusted odds ratio: 0.59; 95% CI: 0.56-0.63) and rural (adjusted odds ratio: 0.67; 95% CI: 0.61-0.74) patients. Naloxone administration decreased during the pandemic in both urban (adjusted odds ratio: 0.69; 95% CI: 0.65-0.72) and rural (adjusted odds ratio: 0.84; 95% CI: 0.77-0.92) settings. Endotracheal intubation rates were lower in rural (adjusted odds ratio: 0.74; 95% CI: 0.62-0.88) and urban (adjusted odds ratio: 0.67; 95% CI: 0.61-0.74) settings during COVID-19, with rural patients consistently showing lower odds compared to pre-COVID urban patients.The COVID-19 pandemic was associated with a reduction in critical interventions for opioid overdoses reported to poison centers, highlighting potential disruptions or changes in overdose management across both urban and rural settings.DISCUSSIONThe COVID-19 pandemic was associated with a reduction in critical interventions for opioid overdoses reported to poison centers, highlighting potential disruptions or changes in overdose management across both urban and rural settings.These findings add to evidence that the COVID-19 pandemic may have disrupted overdose care protocols, potentially impacting outcomes for individuals with opioid-related emergencies.CONCLUSIONSThese findings add to evidence that the COVID-19 pandemic may have disrupted overdose care protocols, potentially impacting outcomes for individuals with opioid-related emergencies.

Telehealth and the opioid crisis during COVID-19: urban-rural disparities in emergency care and poison center teleconsultations

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