Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 4:36:102494.
doi: 10.1016/j.pmedr.2023.102494. eCollection 2023 Dec.

Polysubstance use and post-discharge mortality risk among hospitalized patients with opioid use disorder

Karli R Hochstatter  1 , Courtney Nordeck  1 , Shannon Gwin Mitchell  1 , Robert P Schwartz  1 , Christopher Welsh  2 , Jan Gryczynski  1
Affiliations

Polysubstance use and post-discharge mortality risk among hospitalized patients with opioid use disorder

Karli R Hochstatter et al. Prev Med Rep. .

Abstract

Polysubstance use is becoming increasingly common and presents several harms. This study aimed to examine the association of comorbid cocaine, alcohol (binge drinking), and sedative use with mortality among hospitalized patients with opioid use disorder (OUD). A subsample of adult medical/surgical hospital patients with OUD who were seen by a hospital addiction consultation service in Baltimore City and enrolled in a randomized trial of a patient navigation intervention were included in this study (N = 314; 45 % female; 48 % White; mean age = 44). Death certificate data from the Maryland Division of Vital Records was used, covering 3.3-5.5 years post-discharge. Multivariable proportional hazards Cox regression and competing risks regression were used to estimate all-cause mortality and overdose mortality, respectively, as a function of concurrent use of cocaine, alcohol (binge drinking), and non-prescribed sedatives at baseline. In the 30 days prior to hospital admission, 230 (73 %) participants used cocaine, 64 (20 %) binge drank, and 45 (14 %) used non-prescribed sedatives. Nearly one-third (N = 98; 31 %) died during the observation period. Drug overdose caused 53 % (N = 52) of deaths. Older age (HR = 1.03 [1.01,1.05]; P = 0.001), less than high school education (HR = 0.36 [0.24,0.54]; P < 0.001), and past 30-day sedative use (HR = 2.05 [1.20,3.50]; P = 0.008) were significantly associated with all-cause mortality. The risk of overdose mortality was 62 % lower (HR = 0.38 [0.22,0.66]; P = 0.001) for those who completed high school. No other characteristics were significantly associated with overdose mortality. The concurrent use of opioids and sedatives increases the post-discharge mortality risk among hospitalized patients with OUD. Interventions are needed to prevent mortality among this high-risk population.

Keywords: Hospitalized patients; Opioid use disorder; Overdose; Polysubstance use; Sedatives; Substance use disorder.

PubMed Disclaimer

Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: The authors have no conflicts of interest but make the following disclosures that are unrelated to the present study: JG is part owner of COG Analytics LLC and has received research funding from Indivior (paid to his institution and including project-related salary support). JG and RPS were investigators on a NIDA-funded study receiving in-kind medication from Indivior and Alkermes. SGM is MPI on a NIDA study that was provided medication in-kind by Braeburn.

Figures

Fig. 1
Fig. 1
Cox proportional hazards regression survival curves among hospitalized patients with OUD (N = 314), by concurrent sedative use; 2016–2021.
See this image and copyright information in PMC

References

    1. Ahmed S., Sarfraz Z., Sarfraz A. Editorial: a changing epidemic and the rise of opioid-stimulant co-use. Front. Psychiatry. 2022;13 doi: 10.3389/fpsyt.2022.918197. - DOI - PMC - PubMed
    1. Ashman, J.J., Hermer, L., DeFrances, C., Schwartzman, A. Exploring Hospital-Based Mortality - Examples from the 2014 National Hospital Care Survey data linked to the National Death Index. Accessed March 9, 2023. https://www.cdc.gov/nchs/data/nhcs/opioid_involved_hospitalization_NDI.pdf.
    1. Broton K. Poverty in American Higher Education: the relationship between housing insecurity and academic attainment. J. Postsecondary Student Succ. 2021;1:18–45. doi: 10.33009/fsop_jpss129147. - DOI
    1. Buckley C., Ye Y., Kerr W.C., et al. Trends in mortality from alcohol, opioid, and combined alcohol and opioid poisonings by sex, educational attainment, and race and ethnicity for the United States 2000–2019. BMC Med. 2022;20(1):405. doi: 10.1186/s12916-022-02590-z. - DOI - PMC - PubMed
    1. Cho J., Spence M.M., Niu F., Hui R.L., Gray P., Steinberg S. Risk of overdose with exposure to prescription opioids, benzodiazepines, and non-benzodiazepine sedative-hypnotics in adults: a retrospective cohort study. J. Gen. Intern. Med. 2020;35(3):696–703. doi: 10.1007/s11606-019-05545-y. - DOI - PMC - PubMed

LinkOut - more resources