RT Journal Article
SR Electronic
T1 Death after emergency department visits for opioid overdose in British Columbia: a retrospective cohort analysis
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E242
OP E251
DO 10.9778/cmajo.20200169
VO 9
IS 1
A1 Jessica Moe
A1 Mei Chong
A1 Bin Zhao
A1 Frank X. Scheuermeyer
A1 Roy Purssell
A1 Amanda Slaunwhite
YR 2021
UL http://www.cmajopen.ca/content/9/1/E242.abstract
AB 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.