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Mortality risk high after nonfatal opioid overdose
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In the year following nonfatal opioid overdose, patients died at about 24 times the rate of the general population, data published in JAMA Psychiatry showed.
However, most of these deaths were not attributable to overdose; instead, the most common immediate causes were substance use-related diseases, circulatory diseases and cancer.
“Over the past several years, we’ve seen a marked increase in opioid overdoses,” study author Mark Olfson, MD, MPH, from New York State Psychiatric Institute, department of psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, told Healio Psychiatry. “In order to provide effective health care for this patient population, it is important to understand their health care needs. Studying their risks of mortality provides a window into their health care needs.”
In this national longitudinal study, researchers examined all-cause mortality rates, selected cause-specific mortality rates and standardized mortality rate ratios among adults enrolled in Medicaid during their first year after nonfatal opioid overdose.
Using Medicaid data from 2001 through 2007 and death record data from the National Death Index, they estimated crude mortality rates per 100,000 person-years in the year after nonfatal opioid overdose and standardized mortality rate ratios for all-cause and selected cause-specific mortality. Selected immediate causes of death included external causes excluding substance use–related causes (suicide, homicide and unintentional injuries); causes related to substance abuse; infectious diseases; diseases of the circulatory system; respiratory diseases; digestive system diseases; and cancers.
The study included 76,325 adults with a follow-up of 66,736 person-years. In the first year following nonfatal opioid overdose, 5,194 deaths occurred. Analysis revealed the crude death rate was 778.3 per 10,000 person-years, which was more than 20 times higher than the death rate of age, sex and race/ethnicity–matched controls. The all-cause standardized mortality rate ratio was 24.2 (95% CI, 23.6-24.9).
In the overall cohort, the most common immediate cause of death was substance use–related diseases (26.2%), followed by diseases of the circulatory system (13.2%) and cancer (10.3%). The standardized mortality rate ratio for each cause of death examined was significantly greater than the standardized reference population and was highest for drug use–associated deaths (standardized mortality rate ratio = 132.1; 95% CI, 125.6-140). HIV, chronic respiratory disease, viral hepatitis and suicide also had particularly high standardized mortality rate ratios. Women more so than men were at exceptionally high risk for suicide following nonfatal overdose.
“The results of this study indicate that people who survive opioid overdoses are extremely vulnerable, not just to serious recurrent substance use problems, but also to dying of suicide and many medical illnesses,” Olfson told Healio Psychiatry. “These findings highlight the need to coordinate substance use, medical and mental health care after nonfatal overdoses.” – by Savannah Demko
Disclosure: Olfson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.