Repeat emergency room visits due to opioid overdoses have increased during the pandemic, Vermont Health Department finds

From 2018 to 2021, 237 Vermont residents have been treated in an emergency room at least twice for opiate overdoses, according to a new state report — and nearly a quarter of repeat trips to the emergency room occurred within 30 days of the person’s first visit.

The rate of overdose-related repeat visits to the emergency department within a 30-day period increased from 2% of all overdose emergency visits in 2019 to 4% in 2021.

The report, released Wednesday, marks the first time the Vermont Department of Health has analyzed patterns of repeat emergency room visits due to opiate overdoses. It comes as the state has seen a steady increase in both fatal and nonfatal opioid overdoses since the coronavirus pandemic began in 2020.

The latest figures from the health department show that as of June, 94 Vermonters had died this year from opioid overdoses. As of June 2019, the total for that year was 48 fatal opioid overdoses — roughly half the current figure.

For nonfatal overdoses, one of the factors the state tracks is emergency room visits after an overdose. As of this June, the statewide rate was 28.5 overdose-related visits per 10,000 emergency room visits. In the same month three years ago, the rate was just 10.3 per 10,000 emergency room visits.

The health department said the emergency room visit analysis will guide the state in its efforts to prevent more overdoses. Health officials also would like more people who have overdosed to visit emergency rooms, where they can receive not only medical care but also referrals to other support services.

“We really want to make sure people get the care they need,” said Nicole Rau Mitigui, the department’s substance abuse prevention manager. “So if our overall number of overdoses is going up in Vermont, we would want that number of visits or return visits, whatever that looks like, to go up in the emergency room accordingly.”

The report states that follow-up care is important given “the lethality of fentanyl and the increased likelihood of new substances such as xylazine in the drug supply.” Xylazine is an animal tranquilizer increasingly linked to opioid overdose deaths.

The report analyzed emergency room visits only at Vermont hospitals and counted multiple visits to the same emergency room as repeat visits. Because a Vermont resident who overdosed may have gone to an out-of-state hospital or multiple in-state hospitals, Mitigui said it’s possible that the rate of emergency room visits over the four-year study period was actually higher.

The analysis also shows that among Vermont counties, from 2018-2021, Rutland had the highest rate of emergency room repeat visits due to opioid overdoses: 19.9 visits per 100 emergency room visits for opioid overdoses.

The second highest was in Bennington County, with 18 per 100 emergency room visits for opioid overdoses, compared to 14.5 for the state as a whole. The report noted that data for Brattleboro Memorial Hospital was not included in the study, so counties whose residents visited Brattleboro’s emergency room may have recorded lower numbers.

Patient demographics show that women aged 30-39 years have the highest rate of repeat visits to the ED for opiate overdose, with 20% of all visits being repeat visits.

Addiction recovery specialists say a significant number of people who overdose do not seek emergency treatment. Reasons include fear of getting in trouble with the law or a greater intent to find the substance that would ease withdrawal symptoms after being revived with an opioid antidote.

“Most of the time, people refuse to go to the hospital,” said Margie Diamond, director of Turning Point Recovery Center in Bennington. “They’re disoriented, they’re scared, and they’re in such bad withdrawal that they don’t want anyone to get in the way of what they feel they need right now.”

Another reason is that serious mental health issues can prevent a person from understanding the importance of going to the emergency room, said Tracy Hauck, director of the Rutland Turning Point Center.

“Trying to talk to these people is difficult,” she said. “Sometimes their mental health is so unstable that they don’t have the ability to really focus on dealing with their substance use.”

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