Abstract
BackgroundSince the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions.MethodsThis was a retrospective cohort study at six Level I trauma centers across four states. Patients admitted during the period after the onset of the COVID-19 restrictions (defined as March 16, 2020-May 31, 2020) were compared with those admitted during the same time period in 2019. We compared 1) rate of urine drug screens and blood alcohol screens; 2) rate of positivity for drugs or alcohol (blood alcohol concentration ≥ 10 mg/dL); 3) characteristics of patients who were positive for drug or alcohol, by period using chi-squared tests or Fisher’s exact tests, as appropriate. Two-tailed tests with an alpha of p < 0.05 was used on all tests.ResultsThere were 4762 trauma admissions across the study period; 2602 (55%) in 2019 and 2160 (45%) in 2020. From 2019 to 2020, there were statistically significant increases in alcohol screens (34% vs. 37%, p = 0.03) and drug screens (21% vs. 26%, p < 0.001). Overall, the rate of alcohol positive patients significantly increased from 2019 to 2020 (32% vs. 39%, p = 0.007), while the rate of drug positive patients was unchanged (57% vs. 52%, p = 0.13). Of the 1025 (22%) patients who were positive for alcohol or drugs, there were significant increases in a history of alcoholism (41% vs. 26%, p < 0.001), and substance abuse (11% vs. 23%, p < 0.001) in the 2020 period. No other statistically significant differences were identified among alcohol or drug positive patients during COVID-19 compared to the same period in 2019.ConclusionsOur first wave of COVID-19 data suggests that trauma centers were admitting significantly more patients who were alcohol positive, as well those with substance use disorders, potentially due to the impact of social restrictions and guidelines. Further longitudinal research is warranted to assess the alcohol and drug positive rates of trauma patients over the COVID-19 pandemic.
Highlights
Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions
Studies have shown that social isolation and loneliness are associated with alcohol and drug abuse and previous health-related disasters have led to posttraumatic stress disorder (PTSD) and alcohol dependence. (Reynolds et al 2008; Sprang and Silman 2013; Taylor et al 2008; Wu et al 2009; Wu et al 2008) Among 1074 people surveyed from Hubei and other provinces during the COVID-19 pandemic, hazardous drinking increased and alcohol dependency reached 1.6% among young people, (Ahmed et al 2020) while in the United Kingdom the number of high risk drinkers has almost doubled during lockdown. (The Telegraph 2020)
Consequences apply to substance users who, as a result of the COVID-19 restrictions, may no longer have access, potentially resulting in alcohol and drug withdrawal complications. (Columb et al 2020; Rehm et al 2020) numerous studies indicate the potential for a perfect storm between substance use disorders (SUDs) and COVID-19, (Columb et al 2020; Narasimha et al 2020; Satre et al 2020; Spagnolo et al 2020) there is currently a dearth of literature on how this applies to the US healthcare system
Summary
Since the national stay-at-home order for COVID-19 was implemented, clinicians and public health authorities worldwide have expressed growing concern about the potential repercussions of drug and alcohol use due to social restrictions. We explored the impact of the national stay-at-home orders on alcohol or drug use and screenings among trauma admissions. (CNN 2020) Subsequently, individual states began to issue stay-at-home or shelter-in-place orders as well. (Kaiser Family Foundation 2020) To date (December 2020), state mandates to minimize transmission of the virus persist, including but not limited to mandatory face masks in public places, social distancing of six feet, and varying restrictions on size of social gatherings. Consequences apply to substance users who, as a result of the COVID-19 restrictions, may no longer have access, potentially resulting in alcohol and drug withdrawal complications. Traumatic injuries are still occurring during the lockdown, but there are minimal patient data examining alcohol or drug use during COVID-19 within trauma centers
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