Review of Neurologic Comorbidities in Hospitalized Patients With Opioid Abuse

Abstract

Purpose of review:Determine the prevalence and burden of neurological comorbidities in hospitalized patients with opioid abuse.Recent findings:From one year of hospital discharges 2,182 opioid abuse patients were identified (prevalence 6.3%), with abuse greater among younger patients (p<0.0001), women (p<0.0001), whites (p<0.0001), and urban population (p=0.028). Matching for age, sex, race, and urban-rural residence, 347 patients were reviewed and 179 (52%) had a neurological comorbidity. The comorbidities frequently overlapped and included: encephalopathy (130), neuromuscular disorders (42), seizures (23), spine disorders (23), strokes (20), central nervous system infections (3), and movement disorders (2). Abuse patients with neurologic comorbidities experienced substantially greater number of hospital and intensive care unit days and mortality, independent of overdose.Summary:Neurological comorbidities are a frequent and heretofore underappreciated contributor to the disease burden of hospitalized patients with opioid abuse. The importance of neurological comorbidities should be included in the public health discussions surrounding the opioid epidemic.

Opioid Overdose-Induced Diffusion Restriction in the Bilateral Basal Ganglia Revealed on Brain Imaging

“…Neurologically, the effects of opioid overdose have been sparingly described. Nelson et al and Andalibi et al found that opioid abuse was associated with frequent comorbidities of encephalopathy, neuromuscular disorders, seizures, spine disorders, strokes, central nervous system (CNS) infections, and movement disorders, with opioid use disorder specifically increasing the hazard ratio of stroke mortality without an effect on the disability rate [ 7 , 8 ]. Birsic et al described the case of a 37-year-old female with a history of intravenous drug use who presented with extremity weakness and pain and was found to have large endocardial vegetation on both the tricuspid and mitral valves with a patent foramen ovale, prompting embolization of these vegetations into the lungs, liver, and brain [ 9 ].…”