24 Sep UBC Studies Rate of Overdoses After Leaving Hospital AMA

MedicalResearch.com Interview with:

Mayesha Khan, M.A.
Research Coordinator
Staples Lab | Road Safety & Public Health Research

Dr. Staples

Dr. John A. Staples MD, FRCPC, MPH
Clinical Associate Professor
Department of Medicine

The University of British Columbia | VCH Research Institute

MedicalResearch.com: What is the background for this study?

Response: About one in thirty patients leave hospital before their inpatient medical treatment is complete. Before medically advised (BMA) discharge from hospital (also known as patient-initiated discharge) is associated with a several-fold increase in mortality in the following year compared to routine physician-advised discharge. The study’s senior author is a physician who works in the hospital (JS), and it’s the patients who initiate a BMA discharge that he often worries about the most.

We knew from past research that the rate of BMA discharge is much higher among people who use drugs. We suspected that the risk of drug overdose after BMA discharge was much higher than the risk of overdose after routine physician-advised discharge.

We also suspected that BMA discharge itself might create conditions that encourage drug use and increase the risk of overdose. A hospital stay can result in drug abstinence and reduced drug tolerance, and it can disrupt social routines and interfere with access to familiar/safer sources of drugs. BMA discharges sometimes occur suddenly, leaving little time to prescribe medications for opioid use disorder like methadone and Suboxone. Lingering illness or persistent pain after leaving hospital might prompt people to engage in heavier-than-usual drug use. All of these factors might increase the risk of overdose after BMA discharge.

MedicalResearch.com: What are the main findings?

Response:  In our study, we used linked administrative data to examine 189,808 hospitalizations from British Columbia, Canada, between 2015 and 2019. Compared to patients who underwent a routine physician-advised discharge, patients who initiated a BMA discharge were 10 times more likely to experience a drug overdose in the first 30 days after leaving hospital (unadjusted hazard ratio, 10.1; 95%CI, 8.5-11.9). The unadjusted risk of fatal overdose was 6 times higher (unadjusted hazard ratio, 6.4; 95%CI, 3.7-10.9).

After adjusting for many other risk factors for overdose (e.g., male sex, younger age, being unhoused, prior overdoses, history of substance use disorder), we found the risk of overdose was almost 60% higher after BMA discharge relative to routine physician-advised discharge (adjusted hazard ratio, 1.6; 95%CI, 1.3-1.9). This suggests that the BMA discharge itself (and the often-chaotic transition it represents) increases the risk of overdose.

MedicalResearch.com: What should readers take away from your report?

Response: About half a million patients initiate a BMA discharge in the United States each year. A take-away for clinicians is that patients who initiate a BMA discharge have an extraordinary high risk of overdose in the next 30 days. Some of that risk is caused by the BMA discharge itself, so actions that smooth that often-chaotic and stressful transition might help prevent overdose (e.g., sending prescriptions to the patient’s outpatient pharmacy, setting up short term follow-up, asking community-based primary care providers to try to re-engage the patient in care).

Hospitals should develop evidence-based measures to prevent BMA discharge. These might include involvement of specialist addictions medicine consult teams, managing pain/withdrawal, starting treatment for substance use disorders, allowing peer support groups in hospitals.

Health systems should have protocols in place that facilitate an organized response to a BMA discharge. We suspect that evidence-based protocols could reduce variations in the care that patients receive after BMA discharge (e.g., ensuring all patients with substance use disorders are offered follow-up addictions care), and this might reduce the risk of drug overdose. 

MedicalResearch.com: What recommendations do you have for future research as a results of this study?

Response: Our study sheds light on a problem that can be approached from various angles. Future studies might want to examine the medical and psycho-social factors at play in the period between BMA discharge and drug overdose to identify other effective avenues for interventions.

MedicalResearch.com: Is there anything else you would like to add? Any disclosures?

Response: Drug overdose deaths are preventable. Decision-makers at all levels of health systems need to enact evidence-based protocols to prevent BMA discharge and explore novel means of post-departure outreach.

We do not have any conflicts of interest to report.

Citation:

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Last Updated on September 24, 2024 by Marie Benz MD FAAD