{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T14:02:15Z","timestamp":1789135335561,"version":"build-2803163510"},"reference-count":41,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2022,9,7]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"\n Importance<\/jats:title>\n The COVID-19 pandemic impacted healthcare beyond COVID-19 infections. A better understanding of how COVID-19 worsened the opioid crisis has potential to inform future response efforts.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To summarize changes from the COVID-19 pandemic on outcomes regarding opioid use and misuse in the USA and Canada.<\/jats:p>\n <\/jats:sec>\n \n Evidence review<\/jats:title>\n We searched MEDLINE via PubMed, EMBASE, and CENTRAL for peer-reviewed articles published between March 2020 and December 2021 that examined outcomes relevant to patients with opioid use, misuse, and opioid use disorder by comparing the period before vs after COVID-19 onset in the USA and Canada. Two reviewers independently screened studies, extracted data, assessed methodological quality and bias via Newcastle-Ottawa Scale, and synthesized results.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n Among 20 included studies, 13 (65%) analyzed service utilization, 6 (30%) analyzed urine drug testing results, and 2 (10%) analyzed naloxone dispensation. Opioid-related emergency medicine utilization increased in most studies (85%, 11\/13) for both service calls (17% to 61%) and emergency department visits (42% to 122%). Urine drug testing positivity results increased in all studies (100%, 6\/6) for fentanyl (34% to 138%), most (80%, 4\/5) studies for heroin (-12% to 62%), and most (75%, 3\/4) studies for oxycodone (0% to 44%). Naloxone dispensation was unchanged and decreased in one study each.<\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n Significant increases in surrogate measures of the opioid crisis coincided with the onset of COVID-19. These findings serve as a call to action to redouble prevention, treatment, and harm reduction efforts for the opioid crisis as the pandemic evolves.<\/jats:p>\n <\/jats:sec>\n \n PROSPERO registration number<\/jats:title>\n CRD42021236464.<\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/rapm-2022-103591","type":"journal-article","created":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T20:00:10Z","timestamp":1665086410000},"page":"37-43","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Impact of the COVID-19 pandemic on opioid overdose and other adverse events in the USA and Canada: a systematic review"],"prefix":"10.1136","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9011-3479","authenticated-orcid":false,"given":"Siddartha","family":"Simha","sequence":"first","affiliation":[{"name":"Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuf","family":"Ahmed","sequence":"additional","affiliation":[{"name":"University of Michigan Medical School, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chad M","family":"Brummett","sequence":"additional","affiliation":[{"name":"Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA"},{"name":"Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer F","family":"Waljee","sequence":"additional","affiliation":[{"name":"Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA"},{"name":"Surgery, Michigan Medicine, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Englesbe","sequence":"additional","affiliation":[{"name":"Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA"},{"name":"Surgery, Michigan Medicine, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9406-5953","authenticated-orcid":false,"given":"Mark C","family":"Bicket","sequence":"additional","affiliation":[{"name":"Anesthesiology, Michigan Medicine, Ann Arbor, Michigan, USA"},{"name":"Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"2025101109290260000_48.1.37.1","unstructured":"Reuters . Daily statistics in northern America, 2021. Available: https:\/\/graphics.reuters.com\/world-coronavirus-tracker-and-maps\/regions\/northern-america\/"},{"key":"2025101109290260000_48.1.37.2","first-page":"95","article-title":"Covid-19 pandemic impact on mental health of vulnerable populations","volume":"91","author":"Amerio","year":"2020","journal-title":"Acta Biomed"},{"key":"2025101109290260000_48.1.37.3","doi-asserted-by":"crossref","first-page":"1740","DOI":"10.15585\/mmwr.mm7050e3","article-title":"Trends in and characteristics of drug overdose deaths involving Illicitly manufactured Fentanyls \u2014 United States, 2019\u20132020","volume":"70","author":"O\u2019Donnell","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025101109290260000_48.1.37.4","unstructured":"Goodnough A , Katz J , Sanger-Katz M . Drug overdose deaths drop in U.S. for first time since 1990. The New York Times, 2019."},{"key":"2025101109290260000_48.1.37.5","unstructured":"Government of Canada . Opioid- and Stimulant-related harms in Canada, June 2022, 2022. Available: https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/graphs?index=477 [Accessed 16 Sep 2022]."},{"key":"2025101109290260000_48.1.37.6","doi-asserted-by":"crossref","DOI":"10.1016\/j.drugalcdep.2021.108617","article-title":"Impacts of the COVID-19 pandemic on healthcare access among patients receiving medication for opioid use disorder","volume":"221","author":"Jacka","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"2025101109290260000_48.1.37.7","first-page":"137","article-title":"Mental health outcomes of the CoViD-19 pandemic","volume":"55","author":"Talevi","year":"2020","journal-title":"Riv Psichiatr"},{"key":"2025101109290260000_48.1.37.8","unstructured":"Kochhar R . Unemployment rose higher in three months of COVID-19 than it did in two years of the great recession., 2020 Pew Research Center. 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SAEM21 Abstract #96: Collateral consequences of COVID-19: A rising tide of opioid overdoses. 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Drug overdose deaths in the U.S. top 100,000 annually, 2021. Available: https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2021\/20211117.htm [Accessed 16 Sep 2022]."},{"key":"2025101109290260000_48.1.37.37","unstructured":"Hedegaard H , Mini\u00f1o AM , Warner M . Drug overdose deaths in the United States, 1999-2018 key findings data from the National vital statistics system, mortality, 1999. Available: https:\/\/www.cdc.gov\/nchs\/products\/index.htm"},{"key":"2025101109290260000_48.1.37.38","unstructured":"Bernstein L , Achenbach J . Drug overdose deaths soared to a record 93,000 last year. 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