If Opioid Addicts Survive OD, Other Hazards Lie Ahead: Study
Survivors of an opioid overdose may consider themselves lucky, but they remain at heightened risk of dying -- not just from drugs, but from a host of medical problems or suicide, a new study finds.
Compared with the general population, patients who lived through an opioid overdose were 130 times more likely to die of drug-use-related causes in the following year, the researchers found.
These "lucky ones" were also 45 times more likely to die of HIV, 40 times more likely to die of chronic respiratory diseases and nearly 30 times more likely to die of viral hepatitis. Risk of suicide was 25 times greater.
"These are dramatically elevated risks of mortality," said lead researcher Dr. Mark Olfson, a professor of psychiatry and epidemiology at Columbia University.
The number of Americans who overdose on narcotics has risen dramatically in recent years, as has the number whose lives are cut short by drug abuse.
In 2016, more than 64,000 Americans died from drug overdoses, many involving opioids. Many more survived an overdose, according to the U.S. Centers for Disease Control and Prevention.
Even if an overdose doesn't result in death, it's a signal that the risk of dying from another cause or an overdose is greatly increased, the study suggests.
"Adults who survive heroin or prescription opioid overdoses are a medically frail population," Olfson said.
"The study findings bring a new perspective to the health care needs of people who survive opioid overdoses," he said. "Instead of just focusing on treating their drug use problems, we also need to ensure that these patients receive necessary medical and mental health care."
Dr. Marc Larochelle, an internist and researcher at Boston Medical Center's Grayken Center for Addiction, agreed.
"By focusing only on overdose deaths, we are missing a substantial amount of the mortality burden associated with people who use opioids," said Larochelle.
For the study, Olfson and colleagues collected data on more than 76,300 Medicaid patients who survived a narcotic overdose between 2001 and 2007. Within a year of their overdose, nearly 5,200 died.
The report was published online June 20 in the journal JAMA Psychiatry.
The researchers cautioned that the study doesn't prove cause and effect.
Also, the risk of dying after an overdose may be different today. Two significant factors are the growing use of naloxone to treat overdoses and the use of prescription drugs to wean people off narcotics.
The profile of opioid users may have changed, too, with painkiller and heroin abuse prevalent throughout all sectors of society.
Larochelle's own study was published June 19 in the Annals of Internal Medicine. In it, he found that after an overdose, treating addiction with the drugs methadone or buprenorphine could substantially reduce deaths from any cause.
Only treating the substance abuse is not enough, he said. "We have to treat the whole person," he added.
Opioid users often have complex medical issues -- some are infectious diseases, some are mental health issues, Larochelle said.
But getting the comprehensive care these people need requires drug treatment programs that also provide access to the health care system in general, he said.
It's important that health care reform and Medicaid expansion remain in force, Larochelle said, "because it's rare that someone only has a substance abuse disorder.
"If the model is going to be just to fund substance abuse treatment without providing health insurance for folks, we are not going to treat these other conditions," he said.
For more on opioid overdose, visit the U.S. National Institute on Drug Abuse.
SOURCES: Mark Olfson, M.D., M.P.H., professor, psychiatry and epidemiology, Columbia University, New York City; Marc Larochelle, M.D., M.P.H., general internist and researcher, Boston Medical Center Grayken Center for Addiction; June 20, 2018, JAMA Psychiatry, online
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