Deaths After Nonfatal Opioid Overdose: Causes and Risk Factors

limp hand holding spilled bottle of pills
limp hand holding spilled bottle of pills
Causes of death in the year after a nonfatal opioid overdose were often related to substance use disorders, as well as to a range of mental health and medical conditions.

Causes of death in the year after a nonfatal opioid overdose were often related to substance use disorders, as well as a range of mental health and medical conditions, in a US national cohort, according to a study published in JAMA Psychiatry.

For this longitudinal study, individuals (n=76,325; 59% women; 69.4% whites; ages 18-64 years; 66,736 person-years of follow-up) from 45 states within the United States who had experienced a nonfatal opioid overdose (ie, from heroin and unintentional overdoses from prescription opioids) between 2001 and 2007 were identified using the national Medicaid Analytic Extract from the Centers for Medicare & Medicaid Services, and their data were analyzed.

Individuals from the cohort were followed for a year after the recorded nonfatal overdose, up until their death, or until the end of the study period (2007). Of the 76,325 patients, 5194 died within 1 year (standardized mortality rate [SMR] 24.2; 95% CI, 23.6-24.9; all-cause mortality rate, 778.3 per 10,000 person-years; expected deaths number, 214.6).

The observed death rate after an opioid overdose was found to be 20 times higher in this population compared with in demographics-matched control patients, and the all-cause death rate was found to be higher in younger vs older adults (ages 18-34 years: SMR, 39.1 [95% CI, 36.3-42.1]; ages 45-64 years: SMR, 20.7 [95% CI, 20.0-21.5], respectively), in women vs men (SMR, 27.3 [95% CI, 26.3-28.3] vs SMR, 21.7 {95% CI, 20.9-22.6], respectively), and in whites or Hispanics vs blacks (whites: SMR, 28.6 [95% CI, 27.7-29.6]; Hispanics: SMR, 24.9 [95% CI, 22.0-28.0]; blacks: SMR, 13.1 [95% CI, 12.3-14.0]).

In this cohort, a total of 1363 deaths (26.2%; SMR, 84.6; 95% CI, 80.2-89.2) were attributed to substance abuse-associated conditions. Other causes for fatalities were of a cardiovascular nature (13.2%), cancer-related (10.3%), HIV (3.4%), chronic respiratory disease (4.3%), viral hepatitis (0.9%), and suicide (4.2%). For all the causes examined, the SMR was higher in the study population vs a demographics-matched control population.

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After stratifying data by age group, deaths resulting from substance use-related conditions were more prevalent in younger vs older individuals (ages 18-34 years: SMR, 137.8 [95% CI, 122.6-154.4]; ages 35-44 years: SMR, 92.2 [95% CI, 84.1-100.9]; ages 45-64 years: SMR, 68.1 [95% CI, 62.8-73.6]). Similar trends between age groups and deaths were observed for other causes of fatality (ie, all-cause mortality and cardiovascular).

A total of 61,030 individuals (80.0%) were diagnosed with ≥1 comorbidity in the 3 months preceding the indexed nonfatal opioid overdose, and patients presenting with vs without a comorbidity were found to have higher rates of all-cause mortality in the year after the initial overdose (871.2 vs 416.8 per 10,000 person-years, respectively).

“Adults who survive an opioid overdose are at high risk of dying in the year after the incident, not only from drug use-associated causes but also from suicide and a wide range of general medical diseases,” noted the study authors. “The magnitude of this loss of life and variety of medical diseases that contribute to these excess deaths underscores the medical frailty of these patients and emphasizes the importance of coordinating addiction treatment, general medical services, and mental health care after opioid overdose,” they concluded.

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Olfson M, Crystal S, Wall M, Wang S, Liu SM, Blanco C. Causes of death after nonfatal opioid overdose [published online June 20, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.1471