Patients admitted to ED for drug overdose at increased risk for suicide
Patients admitted to EDs for nonfatal opioid or sedative/hypnotic drug overdose had “exceptionally high” risks for death due to suicide, unintentional overdose and other causes, according to results of a retrospective cohort study published in American Journal of Preventive Medicine.
Thus, ED-based interventions may reduce these patients’ overdose and other mortality risks, researchers noted.
“Our findings support widespread implementation of ED-based interventions aimed at reducing future overdose risk — and not just among ED patients presenting with opioid overdose, but also among those who have overdosed on sedative/hypnotic drugs," Sidra Goldman-Mellor, PhD, of the department of public health at University of California, Merced, told Healio Psychiatry. “EDs can serve as important partners in implementing harm-reduction strategies, including initiating buprenorphine treatment when opioids are involved, as well as providing warm handoffs to mental health care providers. The findings also suggest the need for integrated models of care that will comprehensively address overdose patients' broad mortality risks.”
The investigators aimed to compare 12-month incidence of fatal unintentional drug overdose, suicide and other mortality among ED patients who presented with nonfatal opioid or sedative/hypnotic overdose using statewide, longitudinally linked ED patient record and mortality data from California. They analyzed data of all residents who presented to a licensed ED at least once between 2009 and 2011 with nonfatal unintentional opioid overdose or sedative/hypnotic overdose, as well as of a 5% random sample that did neither. Goldman-Mellor and colleagues followed participants for 1 year following index ED presentation and used ICD-10 codes to assess death due to unintentional overdose, suicide or other causes. They calculated absolute death rates per 100,000 person-years and standardized mortality ratios relative to the general population.
The researchers reported unintentional overdose death rates per 100,000 person-years following the index ED visit as follows:
- 1,863 following opioid overdose (standardized mortality ratio [SMR] = 106.1; 95% CI, 95.2-116.9);
- 342 following sedative/hypnotic overdose (SMR = 24.5; 95% CI, 21.3-27.6); and
- 31 for reference patients without an index overdose (SMR = 2.6; 95% CI, 2.2-3).
Results also showed suicide mortality rates per 100,000 of 319, 174 and 32 following opioid overdose, sedative/hypnotic overdose and reference visits, respectively. Natural causes mortality rates per 100,000 were 8,058 for patients with opioid overdose, 17,301 for patients with sedative/hypnotic overdose and 3,097 for reference patients, according to Goldman-Mellor and colleagues.
“We were surprised at the magnitude of opioid overdose patients' increased risk for drug overdose death, which was 100-fold higher compared with the demographically matched underlying population," Goldman-Mellor told Healio Psychiatry. "The extremely high death rates among both patient groups, but especially among the sedative/hypnotic overdose patients, were also surprising and concerning." – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.