High Mortality Among Patients With Opioid Use Disorder in a Large Healthcare System

Abstract

Objectives Elevated mortality has been observed among individuals with opioid use disorder (OUD) treated in addiction specialty clinics or programs. Information about OUD patients in general healthcare settings is needed in light of the current effort to integrate addiction services into primary healthcare systems. This study examined mortality rates, causes of death, and associated risk factors among patients with OUD in a large general healthcare system. Methods Mortality data were linked with electronic health records of 2,576 OUD patients cared for in a large university health system from 2006–2014. Results There were 465 deaths confirmed (18.1% of the study participants), corresponding to a crude mortality rate of 48.6 per 1000 person-years and standardized mortality ratio of 10.3 (95% CI, 9.4–11.3). Drug overdose and disorder (19.8%), cardiovascular diseases (17.4%), cancer (16.8%), and infectious diseases (13.5%, including 12% hepatitis C virus [HCV]) were the leading causes of death. HCV (HR: 1.99; 95% CI, 1.62– 2.46) and alcohol use disorder (HR: 1.27; 95% CI, 1.05–1.55) were two clinically important indicators of overall mortality risk. Tobacco use disorder (AHR: 2.58; 95% CI, 1.60–4.17) was associated with increased risk of cardiovascular death, HCV infection (AHR: 2.55; 95% CI, 1.52–4.26) with cancer mortality risk, and HCV (AHR: 1.92; 95%CI, 1.03–3.60) and alcohol use disorder (AHR: 5.44; 95% CI, 2.95–10.05) with liver-related mortality risk. Conclusions Patients with OUD in a general healthcare system demonstrated alarmingly high morbidity and mortality, which challenges health care systems to find innovative ways to identify and treat patients with substance use disorder.

National U.S. time-trends in opioid use disorder hospitalizations and associated healthcare utilization and mortality

“…Due to the lack of cause of death data in the NIS, we are unable to comment on whether the causes of death changed over time, were attributed to OUD or related disorder (hepatitis C, HIV, endocarditis, valvular disease) or differed by factors significantly associated with higher mortality. Longer-term studies of mortality up to 4 years after OUD hospitalization found that both opioid use and physical comorbidities contributed to mortality [29,30].…”

Über das Abhängigkeitspotential von Gabapentinoiden

“…In der forensischen Literatur werden seit 10 Jahren insbesondere bei Opiatabhängigen und Politoxikomanen vermehrt Todesfälle beschrieben, die mit einer Überdosierung mit Gabapentinen -und hier insbesondere mit Pregabalin -zusammenzuhängen scheinen [60][61][62]. Es ist nicht ausgeschlossen, dass hier die Überlappung zweier epidemiologischer Trends zum Ausdruck kommt, zum einen die erhebliche Zunahme des Opioidkonsums (v. a. opioderger Analgetika) mit damit verbundener Mortalität [63] und zum andern die zunehmende Verbreitung von Gabapentinoiden mit besonderer Affinität zur Drogenszene [47][48][49]. Ob Gabapentinoide hier tatsächlich grundsätzlich letalitätsfördernd oder durch Verdrängung noch toxischerer Substanzen eine sogar eher protektive Rolle spielen können (z.…”

“…Benzodiazepine sind in 30 % bis 50 % der Todesfälle im Zusammenhang mit der nicht-medizinischen Einnahme von opioidergen Schmerzmitteln involviert [63,145]. Da Gabapentinoide toxikologisch unbedenklicher sind als Benzodiazepine oder auch manche neue psychoaktive Substanz und sie aufgrund ihrer berauschenden Wirkung inzwischen auf dem Schwarzmarkt ("on-und offline") Originalarbeit [47][48][49]69] weit verbreitet sind, besteht die Möglichkeit, dass sie eigentlich gefährlichere Substanzen ersetzen und damit im Sinne einer dann "anti-adversen Selektion" dazu beitragen, dass tatsächlich weniger fatale Fälle auftreten, als ohne die weite Verbreitung von Gabapentinoiden erwartet werden könnten.…”

Dance/Movement Therapy: A Unique Response to the Opioid Crisis

“…Although inpatient medical units have the potential to initiate treatment at an acute level, physicians are often unfamiliar with MAT, creating a barriers for screening and referral (Hassamal et al, 2017). Critically, individuals with opioid use disorder are 10 times more likely to die in the general medical setting compared to the general population (Hser et al, 2017). Severely mentally ill individuals, with chronic psychotic disorders such as schizophrenia are especially vulnerable to providers overlooking SUD care.…”

“…Each region may have limited data online, however, and therapists are encouraged to proactively build their own database of region-specific MAT resources. Innovative approaches are now being called for due to the high rate of morbidity and mortality (Hser et al, 2017) and dance/movement therapists can respond to this by immediately contributing. If we succeed in addressing every patient's substance history starting at the inpatient level, we may continue to discover many positive opportunities and contribute to the healing of the nation's opioid crisis.…”