One-Year Mortality of Patients After Emergency Department Treatment for Nonfatal Opioid Overdose

Abstract

Twitter: @scottweinermd.Study objective: Despite the increased availability of naloxone, death rates from opioid overdose continue to increase. The goal of this study is to determine the 1-year mortality of patients who were treated for a nonfatal opioid overdose in Massachusetts emergency departments (EDs). Methods:This was a retrospective observational study of patients from 3 linked statewide Massachusetts data sets: a master demographics list, an acute care hospital case-mix database, and death records. Patients discharged from the ED with a final diagnosis of opioid overdose were included. The primary outcome measure was death from any cause within 1 year of overdose treatment.Results: During the study period, 17,241 patients were treated for opioid overdose. Of the 11,557 patients who met study criteria, 635 (5.5%) died within 1 year, 130 (1.1%) died within 1 month, and 29 (0.25%) died within 2 days. Of the 635 deaths at 1 year, 130 (20.5%) occurred within 1 month and 29 (4.6%) occurred within 2 days. Conclusion:The short-term and 1-year mortality of patients treated in the ED for nonfatal opioid overdose is high. The first month, and particularly the first 2 days after overdose, is the highest-risk period. Patients who survive opioid overdose should be considered high risk and receive interventions such as being offered buprenorphine, counseling, and referral to treatment before ED discharge.

One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis

“…The incidence of all-cause mortality at 1 year in our study (5.3%) was lower than in 2 previous studies conducted within a US health care plan, 16,17 and similar to that in a recent statewide study in Massachusetts. 23 The rate of opioid-related mortality is higher in the United States than in Canada, which may contribute to differences compared with our study findings. 4,24 However, the variation between studies in the United States may be due to different methods in assessing the outcome.…”

“…The study in Massachusetts could have produced a lower estimate because of challenges with data linkage. 23 As in the previous US health care plan study, we found an increased risk for all-cause mortality among patients with benzodiazepine use. 16 We found discordant results, with an association between mental health and substance-use-related diagnoses and lower all-cause mortality, but higher opioid-related mortality for individuals prescribed opioid agonist therapy.…”

Ambulance Calls for Substance-Related Issues Before and After COVID-19

“…A survey by the American College of Emergency Physicians/Morning Consult discovered that 80% of individuals surveyed were concerned about contracting COVID-19 from another patient or visitor if they needed to go to the emergency department (17). While the initial mortality of patients who refuse transport immediately after naloxone reversal is low (18), this increase in refusal rate is nevertheless concerning, and the one-year mortality of individuals who survive an opioid overdose is quite high (19,20). In part to address this concern, Massachusetts implemented an EMS protocol for "Leave-Behind Naloxone", in which when a patient refuses transport, the patient and/or an accompanying individual can be given a naloxone kit and instructed on its use (21).…”

Progress Report on EMBED: A Pragmatic Trial of User-Centered Clinical Decision Support to Implement EMergency Department-Initiated BuprenorphinE for Opioid Use Disorder

“…Also, there was a 30% increase in ED visits for opioid overdose between 2016 and 2017 [6]. Of 11,557 ED patients in Massachusetts who were treated for a non-fatal opioid overdose, 5.5% died within 1 year, 1.1% within 1 month, and 0.25% within 2 days [7]. As such, patients discharged from the ED following a non-fatal opioid overdose face a high short-term risk of death.…”