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Patients with opioid overdoses seen in the emergency department (ED), if fully recovered, are sometimes discharged home with little to no intervention to prevent future overdoses.
To assess the risk for mortality among Massachusetts ED patients discharged after an opioid overdose, researchers used data sources on acute-care-hospital case mix, demographics, and state death records. Patients seen and discharged for opioid overdose were included if they did not have any documented overdose in the prior 6 months. Death records were matched with patients for 1 year after the overdose visit.
Over a 5-year span, 17,241 overdose patients were treated in Massachusetts EDs, and 11,557 were discharged and included in this analysis. At 1 year, 635 (5.5%), with a median age of 39, had died. Death was more common in the first month (20% of all deaths) and particularly in the first 2 days (4.6% of all deaths; 0.25% of the entire cohort). Most deaths (67.4%) were also attributed to opioid overdoses.
Weiner SG et al. One-year mortality of patients after emergency department treatment for nonfatal opioid overdose. Ann Emerg Med 2019 Jun 19; [e-pub]. (https://doi.org/10.1016/j.annemergmed.2019.04.020)
Comment
These numbers are scary, especially given the young age of those dying. The authors argue, and I agree, that a mortality rate this high warrants a change in how these patients are treated and discharged. Compare it, for example, to the 0 to 1% mortality of low-risk chest pain patients, who have many more resources used in their care. Discharge with no defined treatment plan, especially given growing evidence that medication-assisted treatment saves lives, isn't sufficient for patients with this mortality risk.