Factors associated with opioid overdose: a 10-year retrospective study of patients in a large integrated health care system

Abstract

Objective

Opioid overdoses (ODs) have been increasing, and harm reduction efforts are a priority. The success of these efforts will be dependent on the identification of at-risk patients and improved access to the antidote naloxone. Therefore, to identify access to naloxone and factors associated with negative health outcomes, we conducted a retrospective study of patients with OD to identify those at highest risk of adverse outcomes and to assess the use of naloxone.

Methods

We conducted a study of electronic health records for patients admitted to the largest multihospital system in the region – the Geisinger Health System (GHS) for ODs – from April 2005 through March 2015. ODs were defined by International Classification of Diseases-9 codes (age range: 10–95 years). Bivariate analyses and multiple logistic regressions were conducted to identify pre-OD factors associated with adverse health outcomes post-OD.

Results

We identified 2,039 patients with one or more ODs, of whom 9.4% were deceased within 12 months. Patient demographics suggest that patients with OD had a mean age of 52 years, were not married (64%), and were unemployed (78%). Common comorbidities among patients with OD include cardiovascular disease (22%), diabetes (14%), cancer (13%), and the presence of one or more mental health disorders (35%). Few patients had a prescription order for naloxone (9%) after their OD. The majority of patients with OD were in proximity to GHS health care facilities, with 87% having a GHS primary care provider. In multiple logistic regressions, common predictors of adverse outcomes, including death, repeated ODs, frequent service use, and high service cost, were higher prescription opioid use, comorbid medical conditions, comorbid mental disorders, and concurrent use of other psychotropic medications.

Conclusion

This study suggests opportunities for improving OD outcomes. Those who receive higher quantities of prescription opioids concurrent with other psychotropic medicines may need closer monitoring to avoid death, repeated OD events, higher service use, and higher service costs. Other opportunities for improving OD outcomes include the use of electronic health records to notify physicians of high-risk patients and updating of guidelines/operation manuals focused on the distribution of naloxone to those in highest need.

Keywords:

• opioids
• overdose antidote
• naloxone
• health care access
• health care costs
• services utilization
• prescription drugs

Acknowledgments

The assistance of Joseph J Boscarino is gratefully acknowledged in the preparation of this manuscript. Support for this study included research funding from Indivior, Inc., Richmond, VA, USA. A version of this study was presented at the International Conference on Opioids, Boston, MA, USA, June 5, 2016. This study has not been previously published.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

JAB, HLK, JMP, MHF, and JJH are employees of Geisinger Clinic. VRN and NAR are employees of Indivior, Inc. The authors report no other conflicts of interest in this work.