Hospital Visits for Opioid Overdose Might Spell More Trouble

Opioid overdose hospitalizations associated with further hospitalization and potentially fatal events

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Opioids are strong painkillers that can help manage pain when used properly. But they can cause serious harm, even death, when used inappropriately.

A recent study found that frequent visits to the emergency department due to opioid overdose were associated with an increased likelihood of future hospitalizations and near-fatal outcomes.

The researchers believe that these findings will help health care professionals and policymakers develop comprehensive strategies to prevent and reduce opioid abuse and overdose.

"Take your medications as prescribed."

The lead author of this study was Kohei Hasegawa, MD, MPH, from the Department of Emergency Medicine of the Massachusetts General Hospital at Harvard Medical School in Boston, Massachusetts.

The study included 19,831 adults who visited the emergency department at least once for an opioid overdose between January 1, 2010 and December 31, 2011 in California and Florida.

All participants were listed in the California and Florida State Emergency Department Databases and State Inpatient Databases.

The participants were all over the age of 18 years, and the average age was 42 years old. Forty-three percent of the participants were male and 69 percent were non-Hispanic white.

There were a total of 21,609 emergency department visits for opioid overdose.

The findings showed that 18,442 (93 percent) participants had only one emergency department visit during the study period, compared with 1,389 (7 percent) participants who had two or more emergency room visits during the study period.

Participants who had two or more visits were considered to be frequent visitors to the emergency department. The 7 percent of participants who frequently visited the emergency department accounted for 3,167 (15 percent) of all the visits.

The researchers found that men were 14 percent more likely than women to be frequent visitors.

The participants aged 45 to 54 years old were 19 percent more likely to be frequent visitors than those aged 18 to 34 years old.

The researchers also found that the participants in the lowest tier of household income were 8 percent more likely to frequently visit the emergency department for opioid overdose compared to those in the top tier of household income.

Public insurance was also associated with frequent visits. Those with Medicare were twice as likely, and those with Medicaid were 77 percent more likely, to be frequent visitors of the emergency department compared to the participants with private insurance.

The findings revealed that the participants with chronic pulmonary disease, neurological disorders, substance dependence and psychoses were 29 percent, 31 percent, 65 percent and 44 percent more likely to be frequent visitors to the emergency department due to opioid overdose.

A total of 53 percent of the visits (11,412) resulted in hospitalizations. The participants with frequent visits to the emergency department were almost four times more likely to end up hospitalized after overdose.

Ten percent of the visits (2,161) led to near-fatal events. The participants with frequent emergency department visits were 2.27 times more likely to experience a near-fatal event due to overdose.

"Every incidence of opioid overdose is theoretically preventable, and our findings underscore the importance of integrated and multifaceted strategies to reduce overdoses and the resulting use of health care services," explained Dr. Hasegawa. "Our understanding of characteristics that increase the risks associated with the use of opioid pain medications is still limited, so future studies to better define those risks and develop targeted, prevention-oriented care will be essential to improving the care of patients taking these powerful drugs that can be so important for their quality of life."

The researchers noted the limitations of their study. First, the databases may have had errors. Second, the researchers identified patients from the database by using the primary and secondary diagnosis fields, and there may have been patients that overdosed but were in the hospital for something else.

Furthermore, the databases did not include data on potential affecting factors such as history of chronic pain, use of multiple doctors or dosage of the opioids. Lastly, the study population was not representative of the whole country, so these findings may not be applicable to the general population.

This study was published on March 11 in Mayo Clinic Proceedings.

The Eleanor and Miles Shore Fellowship Program and the Honjo International Scholarship Foundation provided funding.

Review Date: 
March 12, 2014
Last Updated:
March 13, 2014