The numbers tell a familiar but shifting story: as the opioid crisis in the United States deepened, fentanyl took center stage.
A national study of opioid-related hospital use in the United States found that rates of nonfatal overdoses involving synthetic opioids—primarily fentanyl—increased significantly during the COVID-19 pandemic, following a period of decline.
The researchers analyzed over 35 million hospitalizations and 158 million emergency department (ED) visits between 2016 and 2021, identifying major shifts in opioid-related hospital use among U.S. adults.
The most notable change was the rise in nonfatal overdoses involving synthetic opioids, particularly fentanyl, during the COVID-19 pandemic.
From 2019 to 2021, nonfatal opioid overdose rates rose by 8.1% in hospitalizations (from 27.1 to 29.3 per 10,000) and by 24.8% in ED visits (from 23.0 to 28.7 per 10,000). The increase was largely driven by synthetic opioids. ED overdose rates involving synthetic opioids increased by 125.4%, from 1.9 to 4.3 per 10,000 visits. In hospitals, the rate rose by 86.6%, from 3.3 to 6.1 per 10,000 admissions.
Prior to the pandemic, between 2016 and 2019, overall opioid-related diagnoses and treatment rates declined in inpatient settings. Hospitalization rates for nonfatal opioid overdose fell by 18.4% (from 33.2 to 27.1 per 10,000), and substance abuse treatment decreased by 25.1% (from 34.4 to 25.8 per 10,000). However, injection drug use–related acute infections increased by 14.4% (from 13.9 to 15.9 per 10,000), particularly phlebitis and infectious arthritis.
In 2021, there were 166,922 opioid-related hospitalizations and 324,483 ED visits. Among these, 16,663 hospital stays and 72,850 ED visits were for nonfatal opioid overdose. Injection drug use–related infections accounted for 9,810 hospitalizations and 13,912 ED visits, while 12,973 hospitalized patients and 8,686 ED patients received substance abuse treatment.
Demographic subgroup analyses revealed differing trends. From 2016 to 2019, heroin-related adverse events rose by 51.8% among adults aged 65 to 84. Between 2019 and 2021, nonfatal overdose rates remained relatively unchanged among females (−2.2%), non-Hispanic Whites (1.3%), and individuals in the highest income quartile (−4.9%).
During the pandemic, prescription natural or semisynthetic opioids also contributed to higher overdose rates. In hospitals, related overdoses rose by 10.7%, from 11.0 to 12.2 per 10,000. In EDs, the rate increased by 39.0%, from 6.3 to 8.7 per 10,000.
Hospitalizations due to injection drug use–related sepsis or bacteremia rose by 13.7%, from 9.5 to 10.8 per 10,000 between 2019 and 2021. In EDs, these infections increased by 12.5%, from 2.4 to 2.7 per 10,000.
In 2021, most synthetic opioid-related diagnoses in hospitals were associated with fentanyl and its analogs (67.3%), followed by tramadol (24.9%) and other synthetic opioids (8.3%).
“Trends varied greatly by subpopulation, opioid categories, and outcomes,” wrote first author Lingxiao Chen, of the Department of Orthopaedics, Qilu Hospital of Shandong University, in the study published in eClinicalMedicine.
These findings reflect evolving trends in opioid-related hospital use, with significant increases in fentanyl involvement and infection-related complications during the COVID-19 pandemic. The data also underscore differences across age, income, and drug type, signaling a need for differentiated response strategies.
Source: eClinicalMedicine