Opioid Overdose: New Demographic Data Reveal Related Comorbidities

A significant proportion of patients who visit emergency departments (EDs) with opioid overdoses (ODs) also suffer from comorbid mental health disorders, circulatory diseases, and respiratory diseases, according to the results of a new study presented on October 14, 2013, at the American College of Emergency Physicians annual meeting in Seattle.

“Comorbidities, such as mental health disorders and chronic illnesses, should be assessed when prescribing opioids to patients in the community and ED, and when treating patients with acute overdoses,” said Michael Yokell, a third-year medical student at Stanford University School of Medicine.
 
Opioid OD is the leading cause of adult accidental death in the United States, responsible for more than 16,000 deaths in 2009. Most current opioid OD–related research uses hospital discharges and death certificate information. “Little is currently known about the number of ED presentations for opioid OD or the clinical and demographic characteristics of the presenting patients,” said Yokell. “We looked at a nationally representative dataset to help describe the clinical and demographic characteristics of patients presenting to United States EDs with opioid OD.”

The researchers extracted data for patients with diagnosis codes for opioid poisoning in the 2009 Nationwide Emergency Department Sample (NEDS). NEDS sample weights were applied to generate national estimates. A multiple logistic regression, which adjusted for sex, age, opioid type, and comorbidities, was performed to identify potential risk factors for death among patients presenting to the ED with opioid OD. All reported figures represent nationally weighted estimates.

In 2009, there were more than 100,000 ED visits for opioid OD. The mean patient age was 42 years; the large majority (84%) lived in metropolitan areas. Two-thirds of ODs involved prescription opioids, while heroin was involved in about 1 in 5 ODs and methadone involved in about 1 in 10 ODs. The mean age of those overdosing on heroin (35 years) was slightly younger than that of those who overdosed on prescription opioids (44 years). Approximately 15% of patients experienced respiratory failure during their OD.

A significant proportion of patients had comorbid mental health disorders (about one-third), circulatory diseases (more than one-quarter), and respiratory diseases (one-quarter), noted Yokell.

Half of the patients were admitted to the hospital to which they presented, and just less than half were discharged from the ED. Among those presenting to EDs, 1684 died in the ED or as inpatients (1.6%). In multivariate analysis, those who overdosed on heroin and those who suffered respiratory failure had a higher risk of mortality. Of note, a diagnosis of chronic pain was not statistically associated with OD mortality in the multivariate analysis.

“Fatal overdoses from opiates grab lots of headlines, but an equally important story is the huge volume of ED visits for opiate ODs that are not fatal,” said Yokell. “Since treatment in EDs is highly effective at reducing the risk of death from OD, more efforts should be made to ensure that all patients who need treatment for OD have safe and ready access to EDs for lifesaving emergency care.”
 
In conclusion, Yokell said, “Our data demonstrate that there are approximately 63 non-fatal opioid OD visits to US EDs occurring for each OD visit to an ED that results in death.” He said that these figures add critical knowledge to the current literature using hospital discharge data and death records.

Citation: Yokell MA, Zaller ND, Delgado MK, Wang NE, McGowan SK, Green TC/Stanford
University School of Medicine, Stanford, CA; Warren Alpert Medical School of Brown
University, Providence, RI; The Miriam Hospital, Providence, RI. Clinical and Demographic Characteristics Associated With Opioid Overdose Visits to United States Emergency Departments.  Abstract No. 193. Presented October 14, 2013, at the American College of Emergency Physicians annual meeting; October 14-17: Seattle.