Clinical question: What are the causes and risks of mortality in the first year after nonfatal opioid overdose?
Background: The current opioid epidemic has led to increasing hospitalizations and ED presentations for nonfatal opioid overdose. Despite this, little is known about the subsequent causes of mortality in these patients. Additional information could suggest potential interventions to decrease subsequent risk of death.
Study design: Retrospective cohort study.
Setting: U.S. national cohort of Medicaid beneficiaries, aged 18-64 years, during 2001-2007.
Dr. Amanda Breviu
Synopsis: This cohort included 76,325 adults with nonfatal opioid overdose with 66,736 person-years of follow-up. In the first year after overdose, there were 5,194 deaths, and the crude death rate was 778.3 per 10,000 person-years. Compared with a demographically matched general population, the standardized mortality rate ratios (SMRs) for this cohort were 24.2 times higher for all-cause mortality and 132.1 times higher for drug use–associated disease. The SMRs also were elevated for conditions including HIV (45.9), chronic respiratory disease (41.1), viral hepatitis (30.6), and suicide (25.9). Though limited to billing data from Medicaid beneficiaries during 2001-2007, this study is important in identifying a relatively young population at high risk of preventable death and suggests that additional resources and interventions may be important in this population.
Bottom line: Adults surviving opioid overdose remain at high risk of death over the following year and may benefit from multidisciplinary interventions targeted at coordinating medical care and treatment of mental health and substance use disorders following hospitalization and emergency department presentations.
Citation: Olfson M et al. Causes of death after nonfatal opioid overdose. JAMA Psychiatry. 2018 Aug 1;75(8):820-7. Published online June 20, 2018.
Dr. Breviu is assistant professor of medicine and an academic hospitalist, University of Utah, Salt Lake City.