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. 2018 Aug 1;75(8):820-827.
doi: 10.1001/jamapsychiatry.2018.1471.

Causes of Death After Nonfatal Opioid Overdose

Mark Olfson  1 , Stephen Crystal  2 , Melanie Wall  1 , Shuai Wang  1 , Shang-Min Liu  1 , Carlos Blanco  1   3
Affiliations

Causes of Death After Nonfatal Opioid Overdose

Mark Olfson et al. JAMA Psychiatry. .

Erratum in

  • Omission of Grant Number.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2018 Aug 1;75(8):867. doi: 10.1001/jamapsychiatry.2018.2102. JAMA Psychiatry. 2018. PMID: 30073311 Free PMC article. No abstract available.

Abstract

Importance: A recent increase in patients presenting with nonfatal opioid overdoses has focused clinical attention on characterizing their risks of premature mortality.

Objective: To describe all-cause mortality rates, selected cause-specific mortality rates, and standardized mortality rate ratios (SMRs) of adults during their first year after nonfatal opioid overdose.

Design, setting, and participants: This US national longitudinal study assesses a cohort of patients aged 18 to 64 years who were Medicaid beneficiaries and experienced nonfatal opioid overdoses. The Medicaid data set included the years 2001 through 2007. Death record information was obtained from the National Death Index. Data analysis occurred from October 2017 to January 2018.

Main outcomes and measures: Crude mortality rates per 100 000 person-years were determined in the first year after nonfatal opioid overdose. Standardized mortality rate ratios (SMR) were estimated for all-cause and selected cause-specific mortality standardized to the general population with respect to age, sex, and race/ethnicity.

Results: The primary cohort included 76 325 adults and 66 736 person-years of follow-up. During the first year after nonfatal opioid overdose, there were 5194 deaths, the crude death rate was 778.3 per 10 000 person-years, and the all-cause SMR was 24.2 (95% CI, 23.6-24.9). The most common immediate causes of death were substance use-associated diseases (26.2%), diseases of the circulatory system (13.2%), and cancer (10.3%). For every cause examined, SMRs were significantly elevated, especially with respect to drug use-associated diseases (SMR, 132.1; 95% CI, 125.6-140.0), HIV (SMR, 45.9; 95% CI, 39.5-53.0), chronic respiratory diseases (SMR, 41.1; 95% CI, 36.0-46.8), viral hepatitis (SMR, 30.6; 95% CI, 22.9-40.2), and suicide (SMR, 25.9; 95% CI, 22.6-29.6), particularly including suicide among females (SMR, 47.9; 95% CI, 39.8-52.3).

Conclusions and relevance: In a US national cohort of adults who had experienced a nonfatal opioid overdose, a marked excess of deaths was attributable to a wide range of substance use-associated, mental health, and medical conditions, underscoring the importance of closely coordinating the substance use, mental health, and medical care of this patient population.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Blanco owns stock in Eli Lilly Inc, Sanofi, and General Electric. None of these holdings are related to the article. No other disclosures are reported.

Figures

Figure.
Figure.. Cumulative Probability of All-Cause Mortality During the 365 Days After a Nonfatal Opioid Overdose, Stratified by Sex
Log-rank test, χ2 = 150.65; P < .001.
See this image and copyright information in PMC

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