Research Review: Opioid Overdose During the COVID-19 Pandemic.

Golden Gate Bridge, San Francisco, CA

A recent research study (1) aimed to describe the frequency and characteristics of individuals in San Francisco who experienced poor outcomes (e.g., those resulting in ED visits and accidental death) following opioid use during the COVID-19 pandemic. 

The authors reviewed the number of patients who visited emergency departments at the University of California, San Francisco, and Zuckerberg San Francisco General Hospital & Trauma Center (each providing care to 40,000 patients per year) and had a final diagnosis or an “overdose” related to opiate, opioid, heroin, and/or fentanyl. Charts were reviewed from January 1st to April 18th, 2020, capturing the start of the COVID-19 pandemic.

80% of the fatal overdoses were male. Older patients (over 55) were more likely to experience fatal overdoses compared to younger patients.

Survived overdoses: 365 patients were seen at the ED with final diagnoses of “overdose”, 52% of those were opioid-related. 78% were male with a median age of 37 years. During shelter-in-place (March 16th-April 18th), the ED saw approximately 2.5 patients per day with overdose which is an increase compared to 1.4 patients before this period (79% increase in survived overdoses).

  • 16% were related to fentanyl
  • 1% were related to heroin
  • 81% related to non-specified opioid (the exact substance is unknown)

Fatal overdoses: There were 459 deaths, 26% were opioid-related overdoses. 82% were male with a median age of 45 years. During shelter-in-place, there were 1.47 death per day, compared to 0.95 per day before this period (55% increase in fatal overdoses), and were significantly higher than deaths during these months in 2018 & 2019 (see Figure 2).

  • 78% were related to fentanyl
  • 11% were related to heroin
  • 11% related to a combination of fentanyl and heroin 

Figure 2. Opioid-related Average Daily Deaths per Month in Two California-Based Emergency Settings (January-April 2018-2020). 

Those with opioid use disorders are at increased risk of drug-related harm or death during the COVID-19 pandemic. For example, these individuals may:

  1. Be more likely to be in isolation (which may trigger relapse or present a barrier to reversal treatment, e.g., naloxone, a medicine that rapidly reverses an opioid overdose);
  2. Need to seek out new sources of drugs (although it appears that drug supply has not been impacted by COVID-19); and
  3. Use unclean supplies due to limited access to needle/syringe exchange facilities during the pandemic.

Overdose deaths are significantly increasing each year, as shown in Figure 2. Thankfully, there are effective pharmacological and psychological treatments as well as self-support to help people struggling with opioid misuse (see Infographic B. Resources for Opioid Dependence).


Abigail Wright, PhD
Research Staff & Junior Investigator, MGH COE 
Twitter: @DrAbigailW


  1. Rodda, L. N., West, K. L., & LeSaint, K. T. (2020). Opioid Overdose–Related Emergency Department Visits and Accidental Deaths during the COVID-19 Pandemic. Journal of Urban Health, 97(6), 808-813. doi: 10.1007/s11524-020-00486-y