Opioid Overdose Hospitalization Research Articles

Opioid Overdose Hospitalizations During COVID-19: The Experience of Pennsylvania.

The COVID-19 pandemic placed extreme burden on hospitals, while opioid overdose is another challenging public health issue. This study aimed to examine the trends and outcomes of opioid overdose hospitalizations in Pennsylvania during 2018 to 2021. We identified opioid overdose hospitalizations in the state of Pennsylvania using the state-wide hospital discharge database (PHC4) 2018 to 2021. We examined the number of opioid overdose hospitalizations, the corresponding mortality and discharges against medical advice comparing the pre-COVID period (2018-2019) and the COVID period (2020-2021). We also assessed what patient and hospital characteristics were associated with in-hospital death or leaving against medical advice. A total of 13 446 opioid-related hospitalizations were identified in 2018 to 2021. Compared to pre-pandemic, a higher percentage of cases involving synthetics (17.0%vs 10.3%, P < .0001) were observed during COVID. After controlling for covariates, there was no significant difference in opioid overdose in-hospital deaths in the years 2020 to 2021 compared to 2018 to 2019 (OR = 0.846, 95% CI: 0.71-1.01, P = .065). The COVID period was significantly associated with more leaving against medical advice compared to years 2018 to 2019 (OR = 1.265, 95% CI: 1.11-1.44, P = .0003). Compared to commercial insurance, Medicaid insurance was associated with higher odds of both in-hospital death (OR = 1.383, 95% CI: 1.06-1.81, P = .0176) and leaving against medical advice (OR = 1.903, 95% CI: 1.56-2.33, P < .0001). There were no substantial changes in the number of overall opioid overdose cases and deaths at hospitals following the outbreak of COVID-19 in Pennsylvania. This observation suggests that an increased number of patients may have succumbed to overdoses outside of hospital settings, possibly due to a higher severity of overdoses. Further, we found that patients were more likely to leave against medical advice during the COVID-19 pandemic.

Risk of Opioid Overdose Associated With Concomitant Use of Oxycodone and Selective Serotonin Reuptake Inhibitors

Some selective serotonin reuptake inhibitors (SSRIs) inhibit the enzymes responsible for the metabolism of oxycodone, a potent prescription opioid. The clinical consequences of this interaction on the risk of opioid overdose have not been elucidated. To compare opioid overdose rates in patients initiating oxycodone while taking SSRIs that are potent inhibitors of the cytochrome-P450 2D6 enzyme (CYP2D6) vs SSRIs that are not. This cohort study included adults who initiated oxycodone while receiving SSRI therapy between 2000 and 2020 whose data were included in 3 US health insurance databases. Use of SSRIs that strongly inhibit CYP2D6 enzyme (fluoxetine or paroxetine) vs use of other SSRIs at the time of oxycodone initiation. Opioid overdose hospitalization or emergency department visit. Outcomes were assessed within 365 days of oxycodone initiation; in primary analyses, patients were followed up until the discontinuation of either oxycodone or their index SSRI group. Propensity score matching weights were used to adjust for confounding. Crude and weighted (adjusted) incidence rates and hazard ratios were estimated using Cox regression models, separately within each database and overall, stratifying on database. A total of 2 037 490 initiated oxycodone while taking SSRIs (1 475 114 [72.4%] women; mean [SD] age, 50.1 [15.3] years). Most (1 418 712 [69.6%]) were receiving other SSRIs at the time of oxycodone initiation. In the primary analysis, we observed 1035 overdose events (0.05% of the study cohort). The adjusted incidence rate of opioid overdose in those using inhibiting SSRIs at the time of oxycodone initiation (9.47 per 1000 person-years) was higher than in those using other SSRIs (7.66 per 1000 person-years), indicating a greater risk of overdose among patients using CYP2D6-inhibiting SSRIs (adjusted hazard ratio, 1.23; 95% CI, 1.06-1.31). Results were consistent across multiple subgroup and sensitivity analyses. In this cohort study of US adults, initiating oxycodone in patients treated with paroxetine or fluoxetine was associated with a small increased risk of opioid overdose.

Demographic Pattern and Mortality Risk Factors for Prescription Opioid Overdose Hospitalizations: Results From Nationwide Inpatient Sample Analysis.

ObjectivesTo explore the demographic patterns of hospitalizations related to prescription opioid overdose (POD) and evaluate the mortality risk of association in POD inpatients.MethodologyWe conducted a cross-sectional study using the Nationwide Inpatient Sample of 184,711 POD inpatients. A binomial logistic regression model was used to evaluate the odds ratio (OR) of association for mortality risk due to comorbidities (substance use disorders (SUD) and medical complications) in POD inpatients.ResultsPOD inpatients were majorly females (54.1%), older adults aged 51-75 years (48.5%), whites (81.5%), and from lower household income quartet (32.8%). The most prevalent comorbid SUD among POD inpatients was alcohol (15.7%), followed by cannabis (5.7%), cocaine (4.2%), and amphetamine (1.8%). Comorbid alcohol use disorders had a minimally increased association with mortality but were not statistically significant (OR = 1.036; P = 0.438). POD in patients with cardiac arrest had the highest risk of mortality (OR = 103.423; P < 0.001), followed by shock (OR = 15.367; P < 0.001), coma (OR = 13.427; P < 0.001), and respiratory failure (OR = 12.051; P < 0.001).ConclusionsOur study indicates that the hospitalizations related to POD were more prevalent among females, elders between 51 and 75 years of age, whites, and those in the lower household income quartet. The prevalence of prescription opioid use and the hospitalization related to POD remains a significant public health issue. POD inpatients with medical complications were at a higher risk of mortality than with comorbid SUD.

Predictors and Outcomes of Invasive Mechanical Ventilation in Opioid Overdose Hospitalization in the United States.

Introduction Opioid overdose is increasingly becoming common and so is the need for invasive mechanical ventilation (IMV) for opioid overdose admissions in hospitalized patients. Respiratory failure requiring invasive mechanical ventilation is the most common reason for the admission of opioid-associated overdose patients. The aim of our study was to assess the demographic and clinical characteristics associated with the increased need for IMV in hospitalized opioid overdose patients.Methods We analyzed all adult admissions (18 years and above) using the National Inpatient Sample (NIS) database for five years from January 1, 2010-December 31, 2014 to identify opioid overdose patients requiring invasive mechanical ventilation. We compared the demographic and clinical characteristics of opioid overdose patients requiring and not requiring mechanical ventilator support and performed univariate and multivariate analyses to determine the odds ratio (OR) of association.ResultsA total of 2,528,751 opioid overdose patients were identified among which 6.4% required IMV during hospitalization. The prevalence of opioid overdose and the need for IMV increased by 31% and 38%, respectively, over the study period. Multivariate logistic regression (OR (95% CI), p<0.001) determined the following to be associated with increased odds of mechanical ventilator use: (OR 1.12 (1.06-1.19)) among patients aged 25-39 years vs (1.36 (1.28-1.44)) for the age group 40-64 years when compared to 18-24 years; hospital locations in the south US region (OR 1.62 (1.49-1.75)) when compared to the northeast US region; the presence of aspiration pneumonia (OR 14.30 (13.63-15.0)), rhabdomyolysis (3.22 (3.04-3.42)), septic shock (9.15 (8.41-9.97)), and anoxic brain injury (15.5 (13.70-17.50)). Other factors associated with decreased odds of IMV include hepatitis C virus infection (OR 0.75 (0.72-0.79)) and black race (OR 0.68 (0.63-0.74)]. Opioid overdose patients requiring IMV had a higher length of stay by 8.9 ± 0.1 days, higher hospitalization cost by US$ 28,117.81 ± 373.53, and higher in-hospital mortality rate (13.4% vs 0.3%).ConclusionThe prevalence of opioid overdose and the need for IMV increased over the five-year study period, reflecting an increase in the relatively high in-hospital mortality of opioid overdose patients on IMV. Patient’s age, geographic location, race, and several comorbidities affect the need for invasive mechanical ventilation in hospitalized opioid overdose patients. These findings emphasize the need for a better understanding of these risk factors in creating a strategic approach for hospital care of opioid overdose patients.

Frequency of Cardiovascular Events and In-hospital Mortality With Opioid Overdose Hospitalizations

The United States is in the kernel of cataclysmic opioid misuse epidemic with over 33,000 deaths per year from both prescription and illegal opioids use. One of the most common pernicious effects of opioids is on the cardiovascular system. The purpose of this analysis was to determine the incidence of opioid overdose associated cardiovascular events and its impact on short-term outcomes. This was a retrospective, observational study which utilized data from the National Inpatient Sample from January 2005 to September 2015 using International Classifications of Disease, Ninth Revision, Clinical Modification diagnosis codes to identify patients with opioid overdose and associated cardiovascular outcomes. Cardiovascular events were mainly divided into the following 3 parts: Ischemic Events (ischemic stroke and myocardial infarction), acute heart failure, and arrhythmias. The primary outcome of this study was incidence of any cardiovascular event. This study analyzed a total of 430,459 patients hospitalized with opioid overdose, out of which 36,837 (8.6%) had at least 1 cardiovascular event. In all the opioid overdose hospitalizations, 13,979 (3.2%) developed ischemic events, 3,074 (0.7%) developed acute heart failure, and 22,444 (5.2%) developed arrhythmia. Opioid overdose patients with new-onset cardiovascular events had higher odds for in-hospital mortality (odds ratio 4.55; 95% confidence interval 4.11 to 5.04, p <0.001) as compared to patients without cardiovascular events in the multivariable-adjusted model. This study group also demonstrated longer length of stay and higher cost of hospitalization associated with opioid overdose and associated cardiovascular outcome. In conclusion, opioid overdose is associated with higher rates of cardiovascular events, particularly ischemic events and cardiac arrhythmias. These adverse events eventually lead to higher mortality rates and more resource utilization.

Opioid Overdose Hospitalization Trajectories in States With and Without Opioid-Dosing Guidelines.

High-risk opioid-prescribing practices contribute to a national epidemic of opioid-related morbidity and mortality. The objective of this study was to determine whether the adoption of state-level opioid-prescribing guidelines that specify a high-dose threshold is associated with trends in rates of opioid overdose hospitalizations, for prescription opioids, for heroin, and for all opioids. We identified 3 guideline states (Colorado, Utah, Washington) and 5 comparator states (Arizona, California, Michigan, New Jersey, South Carolina). We used state-level opioid overdose hospitalization data from 2001-2014 for these 8 states. Data were based on the State Inpatient Databases and provided by the Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, via HCUPnet. We used negative binomial panel regression to model trends in annual rates of opioid overdose hospitalizations. We used a multiple-baseline difference-in-differences study design to compare postguideline trends with concurrent trends for comparator states. For each guideline state, postguideline trends in rates of prescription opioid and all opioid overdose hospitalizations decreased compared with trends in the comparator states. The mean annual relative percentage decrease ranged from 3.2%-7.5% for trends in rates of prescription opioid overdose hospitalizations and from 5.4%-8.5% for trends in rates of all opioid overdose hospitalizations. These findings provide preliminary evidence that opioid-dosing guidelines may be an effective strategy for combating this public health crisis. Further research is needed to identify the individual effects of opioid-related interventions that occurred during the study period.

Burden of non-fatal opioid overdose hospitalizations on Medicaid

ABSTRACTBackground: The Medicaid population experienced an elevated risk of opioid overdose death. Higher risks of a health condition or worse health outcomes could mean high costs imposed on public sources of insurance. In this study, we compared the length of stay and total charge of hospitalized opioid overdose patients across insurance types to shed light on the financial burden of opioid epidemic across different types of payers. Method: Our sample includes all opioid overdose hospitalizations in the 2012–2013 South Carolina Patient Encounter database. Length of stay and total hospital charge are the two dependent variables. The key independent variable is the insurance status, categorized as: self-pay, commercial insurance, Medicare, Medicaid, and other payers (other government plan and charitable plans). Multilevel models were applied to account for the clustering effect of each hospital. The patients’ age, gender, race/ethnicity, and Charlson Comorbidity Index were used as covariates. Results: A total of 1,262 hospitalizations were included. Medicaid patients stayed longer in hospital (β = 1.815, 95% confidence interval = [0.406–3.224]) and had higher total charge (β = $6,695.2, 95% CI = [215.1–13,175.3) compared with patients with commercial insurance. Conclusion: Medicaid patients’ longer hospitalization and higher hospital charge suggest disparity at the hospital treatment stage.

Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study

ObjectivesTo study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared...

Burden of arrhythmia in hospitalizations with opioid overdose

BackgroundOpioid overdose-related hospitalizations continue to rise in the United States. These hospitalizations are frequently associated with arrhythmia which can increase in-hospital mortality and resource utilization. We describe temporal trends in the hospitalizations for opioid overdose, associated arrhythmias, and their impact on in-hospital mortality, length of stay and cost of hospitalizations. The purpose of this study was to identify incidence of arrhythmia and their impact on in-hospital outcomes with opioid overdose hospitalizations. MethodsThe study utilized data from the National Inpatient Sample from January 2005 to September 2015. Previously employed International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes were utilized to identify opioid overdose and associated arrhythmias. The analysis was performed using SAS (SAS Institute Inc., Cary, NC). Temporal trends were measured using Jonckheere-Terpstra Trend test. ResultsA total of 430,460 adult hospitalizations with opioid overdose were included in this study. Atrial fibrillation (N = 17,695, 4.1%) was the most frequent arrhythmia associated with opioid overdose, the trend of which increased significantly during the study period. All-cause in-hospital mortality increased substantially with arrhythmias, highest with ventricular fibrillation and ventricular tachycardia. The incidence of arrhythmias was associated with longer length of stay and higher cost of hospitalizations as well. ConclusionsIncidence of new-onset arrhythmia with opioid overdose lead to higher in-hospital mortality which can further increase the length of hospitalization and cost of care.

Opioid Overdose Hospitalizations among Medicare-Disability Beneficiaries.

As the opioid epidemic progresses, a better understanding of those at elevated risk of opioid overdose is needed, particularly for populations whose growing risk may be overlooked. Medicare recipients under age 65 (Medicare-disability beneficiaries [MDBs]) are one such population. We sought to analyze characteristics of opioid-overdose hospitalizations among MDBs and quantify the contribution of this population to opioid-overdose hospitalizations overall. This retrospective cohort study included patients hospitalized for opioid overdose in the National/Nationwide Inpatient Sample from 1998 to 2013. The primary outcome measurements were number and characteristics of discharges, including patient sex, age, race, prescription opioid versus heroin overdose, and comorbidities. MDBs constituted 11.7% of US opioid overdose hospitalizations among those under 65 years of age in 1998; this proportion grew to 24.5% by 2013 (P < .0001). The proportion of female patients grew markedly among this cohort (P < .0001) and were disproportionately represented among MDBs (P < .0001). Prescription opioid overdose accounted for a larger proportion of opioid overdose hospitalizations among MDBs than among non-Medicare-insured patients under 65 years old (P < .0001). MDBs generally exhibited greater comorbidity burden versus non-Medicare-insured patients under age 65; however, chronic drug and alcohol abuse were less commonly documented among the Medicare cohort (P < .0001). MDBs constitute a substantial and growing proportion of opioid overdose hospitalizations in the United. To prevent opioid overdoses among MDBs, care must be taken to address the unique needs of this population.

Heroin Overdose Hospitalization Risk due to Prescription Opioids using PDMP in WI.

Objective: Using the Wisconsin Enhanced Opioid Surveillance System, the present study evaluates the heroin hospitalization risk among the opioid recipients using the Prescription Drug Monitoring Data (PDMP) with following specific objectives:1. Evaluate the risk of heroin overdose hospitalization following the prescription of opioid.2. Assess the time elapsed between last prescribed opioid and first heroin overdose hospitalization.3. Identify the main predictors of heroin overdose hospitalization among prescribed opioid users.Introduction: Nationally and in Wisconsin, heroin is the leading cause of opioid related death and hospitalization. Opioids are commonly prescribed for pain. Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids1. In 2015, more than 15,000 people died from overdoses involving prescription opioids1. Approximately, three out of four heroin users report having abused prescription opioids prior to using heroin2. In Wisconsin from 2010 to 2014 the number of deaths involving any opioid increased by 51% and for heroin increased by 192%. Through the federal government funding and support Wisconsin has established a statewide tool to help combat the ongoing prescription drug abuse epidemic by providing valuable information about controlled substance prescriptions that are dispensed in the state. PDMP is continue to be among the most promising state-level interventions to improve opioid prescribing, inform clinical practice, and protect patients at risk.Methods: This was a Retrospective cohort study of PDMP patients who were prescribed an opioid and were subsequently hospitalized for heroin overdose between 2013 and 2015. Our analysis used a combination of univariate and survival data analysis to estimate the risk of heroin overdose hospitalization from the time of the last prescribed opioid to the first day of hospitalization.The outcome was defined as Heroin Hospitalization with any code of 965.01 (ICD9 2013 first quarter to third quarter of 2015), T40.1X1A, T40.1X4A (ICD10 fourth quarter of 2015).The exposure was defined as Prescription of Opioid limited to DEA class I, II, III, &amp; IV.Our analysis used a combination of univariate and survival data analysis to estimate the risk of heroin hospitalization from the time of the last prescribed opioid to first day of hospitalization due to heroin overdose. Cox Regression Hazard modeling was used to analyze survival time data and to identify the main predictors of heroin hospitalization.Data were analyzed using the SAS 9.2 and the study was initiated with the Data Governance Board Approval.Results: From 2013 to 2015, a total of 1,397,493 unique patients that were hospitalized linked to 1,448,224 patients reported in the PDMP who received controlled substance. Among those 699,014 (48%) had at least one hospitalization event and out of those 396 (6%) had at least one hospitalization episode due to heroin. Annual ED visit rates due to heroin overdose have doubled from 179 in 2013 to 396 in 2015. On average, people who stopped receiving prescription drugs were at a 72% increased risk of being hospitalized for heroin overdose within five months with Log-Rank Test significance (p=0.01). Males, 90 morphine milligram equivalent recipients, and kidney disease morbidity were 3.63, 2.99, and 5.64 times higher risk to have heroin overdose hospitalization, respectively.Conclusions: Patients with a history of stopping prescription drugs within the previous five months are at higher risk for subsequent hospitalization for heroin overdose. Factors such as alcohol use, age,gender, and tapering of prescription influence the risk of heroin hospitalization. It may be prudent to transition patients to alternative treatments before they become addicted to the prescribed drugs.

Commentary on Hsu et al. (2017): A systems approach to improving health services for overdose in the hospital and across the continuum of care-an unmet need.

Rising opioid overdose hospitalization rates and costs, stagnant in-hospital mortality rates and poor care transitions highlight the need to improve health services for people who use opioids in the hospital and across the continuum of care. A systems approach may identify opportunities to prevent overdoses and improve outcomes from overdose.

US regional and demographic differences in prescription opioid and heroin-related overdose hospitalizations

BackgroundUS opioid overdose death rates have increased between 2000 and 2014. While, the increase in prescription opioid use has been linked to the increase in heroin use, there are reasons to view this relationship as a partial explanation for the recent increase in heroin-related harms. This study documents the differences in trends in prescription opioid overdose-related (POD) and heroin overdose-related (HOD) hospitalizations. MethodsData come from the National Inpatient Sample (NIS) for the years 2000 through 2014. POD and HOD hospitalizations were abstracted from ICD-9 codes. Rates of POD and HOD by census region and census division were constructed along with separate rates for age and race. Regression analysis analyzing trends across region were estimated along with graphs for documenting differences in POD and HOD rates. ResultsPOD hospitalization rates were highest in the South and lowest in the Northeast. HOD hospitalization rates were highest in the Northeast region and grew the fastest in the Midwest. There was statistically significant heterogeneity in HOD trends but not POD trends across the four regions between 2000 and 2014. Between 2012 and 2014 POD rates decreased in eight of the nine census divisions, with only New England showing an increase. HOD hospitalization rates increased in all nine census divisions between 2012 and 2014. Both POD and HOD rates show different demographic patterns across the nine census divisions. ConclusionComparing POD and HOD hospitalization trends reveals significant disparities in geographic as well as demographic distributions. These epidemics are evolving and the simple opioid-to-heroin transition story is both supported and challenged by this paper. The opioid pill, heroin and fentanyl crises are intertwined yet increasingly have drivers and outcomes that support examining them as distinct. Addressing these complex and interrelated epidemics will require innovative public health research and interventions which need to consider local and regional contexts.