Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis

Jessica Moe; Mei Chong; Bin Zhao; Frank X Scheuermeyer; Roy Purssell; Amanda Slaunwhite

doi:10.9778/cmajo.20200169

Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis

CMAJ Open. 2021 Mar 17;9(1):E242-E251. doi: 10.9778/cmajo.20200169. Print 2021 Jan-Mar.

Authors

Jessica Moe¹, Mei Chong², Bin Zhao², Frank X Scheuermeyer², Roy Purssell², Amanda Slaunwhite²

Affiliations

¹ Department of Emergency Medicine (Moe, Purssell), Vancouver General Hospital; British Columbia Centre for Disease Control (Moe, Chong, Zhao, Slaunwhite); Department of Emergency Medicine (Scheuermeyer), St. Paul's Hospital; British Columbia Drug and Poison Information Centre (Purssell); Department of Emergency Medicine (Moe, Scheuermeyer, Purssell), The University of British Columbia, Vancouver, BC jessica.moe@ubc.ca.
² Department of Emergency Medicine (Moe, Purssell), Vancouver General Hospital; British Columbia Centre for Disease Control (Moe, Chong, Zhao, Slaunwhite); Department of Emergency Medicine (Scheuermeyer), St. Paul's Hospital; British Columbia Drug and Poison Information Centre (Purssell); Department of Emergency Medicine (Moe, Scheuermeyer, Purssell), The University of British Columbia, Vancouver, BC.

Abstract

Background: Visits to the emergency department are critical opportunities to engage individuals after an overdose. We sought to estimate and compare the 12-month mortality between persons with visits to the emergency department related to opioid overdose and those with non-overdose-related visits.

Methods: We conducted a retrospective cohort study using the Provincial Overdose Cohort, which contains data for patients in British Columbia who had an opioid-related overdose between 2015 and 2017, along with a 20% random sample of BC residents for comparison. We examined all nonfatal visits to the emergency department between Jan. 1, 2015, and Dec. 31, 2016, among persons aged 14 to 74 years and compared the 12-month mortality between those with overdose-related visits and those with non-overdose-related visits. We estimated the hazard ratio for death, with adjustment for age, sex, comorbidity and disposition (discharged or left against medical advice).

Results: We included 3593 persons with overdose-related visits and 216 453 with non-overdose-related visits to the emergency department. Those with overdose-related visits were younger, were predominantly male and had more mental health conditions. The 12-month crude mortality probability was 5.4% (95% confidence interval [CI] 4.7%-6.2%) in this group and 1.7% (95% CI 1.6%-1.8%) among those with non-overdose-related visits. After adjustment, for persons who were discharged, the 12-month mortality hazard was 3.5 (95% CI 3.0-4.2) times higher among those with overdose-related visits than those with non-overdose-related visits. For persons who left against medical advice, the mortality hazard was 7.1 (95% CI 4.0-12.5) times higher among those with opioid overdose.

Interpretation: Among persons with overdose-related visits to the emergency department, 12-month mortality was higher than among those with non-overdose-related visits. Overdose-related visits should prompt urgent evidence-based interventions (e.g., take-home naloxone kits, buprenorphine-naloxone induction) to prevent future deaths.

MeSH terms

Adolescent
Adult
Aged
British Columbia / epidemiology
Cohort Studies
Emergency Service, Hospital*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Mortality*
Opiate Overdose / epidemiology*
Proportional Hazards Models
Retrospective Studies
Young Adult