Drug-related mortality after discharge from treatment: A record-linkage study of substance abuse clients in Texas, 2006–2012

Abstract

BackgroundPatients have higher mortality immediately after substance abuse treatment discharge, but there are few data on post-discharge mortality differences across treatment modalities. MethodsA retrospective cohort study examined individuals discharged from substance abuse treatment during 2006–2012 and probabilistically matched treatment records to death records. Logistic regression examined associations between drug-related death (DRD) and demographics; route, frequency, and classes of drugs abused; and treatment. Primary outcome was DRD during post-discharge days 0–28; secondary outcomes examined DRD during days 29–90 and 91–365. ResultsWe examined 178,749 patients discharged from 254,814 treatment episodes. There were 97 DRD during days 0–28 (4.1/1000 person-years), 115 DRD during days 29–90 (2.6/1000 person-years; IRR 0.6 [95% CI 0.5–0.8]), and 293 DRD during days 91–365 (1.9/1000 person-years; IRR 0.5 [0.4–0.6]). Higher 28-day DRD was associated with abuse of opioids (aOR 2.5 [1.4–4.4]), depressants (aOR 2.0 [1.2–3.4]), or alcohol (aOR 1.7 [1.1–2.6]); and opioid injection (aOR 2.2 [1.3–3.7]). Lower DRD was associated with treatment completion (aOR 0.6 [0.4–0.9]), female sex (aOR 0.6 [0.4–0.8]), and employment (aOR 0.5 [0.3–0.9]). Among all patients, DRD rates were higher following residential (IRR 2.6, [1.6–4.2]) and detoxification (IRR 2.9, [1.7–4.9]) treatment compared to outpatient. Patients with prior opioid abuse had higher 28-day DRD after outpatient (6.7/1000 person-years; IRR 4.1 [1.8–9.1]), residential (13.6/1000 person-years; IRR 4.2 [2.2–8.2]), and detoxification (8.8/1000 person-years; IRR 3.2 [1.2, 8.5]) compared to those without. ConclusionsDrug-related mortality is highest during days 0–28 after discharge, especially following residential and detoxification treatment. Opioid abuse is strongly associated with early post-discharge mortality.