New research finds that patients who visited the emergency room for an opioid overdose are 100 times more likely to die by drug overdose in the year after being discharged and 18 times more likely to die by suicide.
The data analysis, funded by the National Institutes of Health, also found that in the year after emergency room discharge patients who visited for a sedative/hypnotic overdose had overdose death rates 24 times higher and suicide rates nine times higher than the general population.
The findings, published in the American Journal of Preventive Medicine, highlight the need for interventions that reduce suicide and overdose risk that can be implemented when patients come to the emergency room, according to researchers.
“We knew that nonfatal opioid and sedative/hypnotic drug overdoses were a major cause of disease. What these new findings show is that overdose patients also face an exceptionally high risk of subsequent death — not just from an unintentional overdose, but also from suicide, non-suicide accidents, and natural causes,” said Sidra Goldman-Mellor, Ph.D., lead study author and an assistant professor of public health at the University of California, Merced.
Deaths by drug overdose increased 225% between 1999 and 2015, with prescription drugs and heroin overdose accounting for the majority of these deaths, researchers reported. Although previous studies have detailed trends in emergency room visits related to opioid and sedative/hypnotic drug overdose, less is known about the risk of death in the year following emergency care for a drug overdose, the researchers said.
“We have tracked and reported patient survival for health concerns, such as cancers and heart surgery, for decades,” said study co-author Michael Schoenbaum, Ph.D., a senior advisor for mental health services, epidemiology, and economics at the National Institute of Mental Health (NIMH), part of the NIH. “We improve what we measure and should be doing the same type of tracking for people with overdose or suicide risk to inform our prevention and treatment programs.”
To learn more about the risks for death that follow a nonfatal opioid overdose, a research team led by Goldman-Mellor examined discharge data for all visits to emergency rooms in California between 2009 and 2011. These data were matched with death records from the California Department of Public Health, which provided information about the date and cause of death for all individuals who died between 2009-2012, the researchers explained.
The researchers focused on patients who visited the emergency room for an opioid overdose (for example, heroin or methadone) or for a sedative/hypnotic drug overdose (such as barbiturate or benzodiazepine) at least once during the 2009-2011 study period.
The data showed that for those who had visited for sedative/hypnotic drug overdose, the death rate in the following year was 18,080 per 100,000. For those who had visited for an opioid overdose, the death rate in the following year was 10,620 per 100,00 patients. The death rates for these groups were significantly higher than the death rate observed in a demographically matched group of Californians (3,236 per 100,000 people), according to the study’s findings.
The researchers discovered that 88% of the unintentional deaths among patients who had visited for opioid overdose were caused by an unintentional overdose (1,863 per 100,000) — a rate 100 times higher than that of the general population. The suicide rate for this group (319 per 100,000 patients), which included some deaths by intentional drug overdose, was 18 times higher than that of the general population, according to the study’s findings.
The researchers also discovered that 60% of unintentional deaths among patients who had visited for sedative/hypnotic overdose were caused by an unintentional drug overdose (342 per 100,00 patients), a rate 24 times higher than that of the general population.
Among those who had previously experienced a sedative/hypnotic drug overdose, the rate of death by suicide (174 per 100,000 patients) was almost nine times higher than the general population, the study found.
“There are already promising emergency department-based interventions that could reduce overdose and other mortality risks, such as suicide, among these patients, but such interventions need to be much more widely implemented,” said Goldman-Mellor. “Moreover, those interventions should target not just patients overdosing on opioids, but also those overdosing on sedative/hypnotic drugs, since blocking RasGRP1 with drugs, or even with gene therapy, may have very little or no major side effects
While the study provides important information about the outcomes of individuals presenting to emergency departments after an overdose, Goldman-Mellor notes that the findings should be replicated in other parts of the U.S. using more recent data, as patterns of opioid and sedative/hypnotic use — and related mortality — have changed substantially over time.
Source: National Institutes of Health
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