Emergency service use is common in the year before death among drug users who die from an overdose

Gjersing, Linn; Jonassen, Kristine V.; Bramness, Jørgen G.; Clausen, Thomas

doi:10.1080/14659891.2016.1208778

Cited by 6 publications

(5 citation statements)

References 39 publications

(35 reference statements)

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“…3 Patients admitted to an ED for an overdose are at greatly elevated risk for a subsequent nonfatal overdose and overdose death. [4][5][6] Thus, the ED encounter has been presented as both a critical and opportune time to prevent recurrent opioid overdoses and death through increased uptake in addiction treatment and provision of other harm reduction and recovery services. 7 However, to our knowledge, there is limited evidence on the most effective ways to promote engagement in treatment after discharge from an ED.…”

Section: Introductionmentioning

confidence: 99%

“…In 2021, more opioid overdose deaths were recorded in the United States than in any prior year, and opioid-related visits to US emergency departments (EDs) increased 4-fold from 2008 to 2018 . Patients admitted to an ED for an overdose are at greatly elevated risk for a subsequent nonfatal overdose and overdose death . Thus, the ED encounter has been presented as both a critical and opportune time to prevent recurrent opioid overdoses and death through increased uptake in addiction treatment and provision of other harm reduction and recovery services .…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

et al. 2022

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IMPORTANCE Fatal and nonfatal opioid overdoses are at record levels, and emergency department (ED) visits may be an opportune time to intervene. Peer-led models of care are increasingly common; however, little is known about their effectiveness. OBJECTIVE To evaluate the effect of a peer-led behavioral intervention compared with the standard behavioral intervention delivered in the ED on engagement in substance use disorder (SUD) treatment within 30 days after the ED encounter. DESIGN, SETTING, AND PARTICIPANTSThis randomized clinical trial recruited 648 patients from 2 EDs from November 15, 2018, to May 31, 2021. Patients were eligible to participate if they were in the ED for an opioid overdose, receiving treatment related to an opioid use disorder, or identified as having had a recent opioid overdose. INTERVENTIONS Participants were randomly assigned to receive a behavioral intervention from a certified peer recovery specialist (n = 323) or a standard intervention delivered by a hospitalemployed licensed clinical social worker (n = 325). A certified peer recovery specialist was someone with at least 2 years of recovery who completed a 45-hour training program and had 500 hours of supervised work experience. After the ED intervention, the certified peer recovery specialists offered continued contact with participants for up to 90 days. MAIN OUTCOMES AND MEASURESThe primary outcome was receipt of SUD treatment within 30 days of enrollment, assessed with deterministic linkage of statewide administrative databases.Treatment engagement was defined as admission to a formal, publicly licensed SUD treatment program or receipt of office-based medication for opioid use disorder within 30 days of the initial ED visit. RESULTS Among the 648 participants, the mean (SD) age was 36.9 (10.8) years, and most were male (442 [68.2%]) and White (444 [68.5%]). Receipt of SUD treatment occurred for 103 of 323 participants (32%) in the intervention group vs 98 of 325 participants (30%) in the usual care group within 30 days of the ED visit. Among all participants, the most accessed treatments were outpatient medication for opioid use disorder (buprenorphine, 119 [18.4%]; methadone, 44 [6.8%]) and residential treatment (44 [6.8%]). CONCLUSIONS AND RELEVANCEOverall, this study found that a substantial proportion of participants in both groups engaged in SUD treatment within 30 days of the ED visit. An ED-based behavioral intervention is likely effective in promoting treatment engagement, but who delivers the (continued) Key Points Question Can peer-led behavioral interventions in the emergency department for patients who have had a recent opioid overdose increase shortterm treatment engagement after the emergency department visit? Findings In this randomized clinical trial of 648 emergency department patients at high risk of opioid overdose, there was no difference in treatment engagement within 30 days of the visit for participants who received a peer-led intervention vs those who received a standard behavioral intervention by a clin...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

et al. 2022

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“…2–4 Frequent hospital and ED use has been linked to greater risk of experiencing both nonfatal and fatal overdoses, 5,6 and both US and international research has found ED utilization to be highest in the months preceding and after overdose. 7–9…”

Section: Introductionmentioning

confidence: 99%

“…[2][3][4] Frequent hospital and ED use has been linked to greater risk of experiencing both nonfatal and fatal overdoses, 5,6 and both US and international research has found ED utilization to be highest in the months preceding and after overdose. [7][8][9] Given that persons at risk of overdose interact frequently with the ED, intervening at this point of contact could be an effective overdose prevention strategy. EDs are especially important intervention points because patients who come into contact with the ED because of overdose or other conditions may not otherwise access the health care system.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study

Krawczyk

Eisenberg

Schneider

et al. 2020

Annals of Emergency Medicine

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Study objective: Persons with substance use disorders frequently utilize emergency department (ED) services, creating an opportunity for intervention and referral to addiction treatment and harm-reduction services. However, EDs may not have the appropriate tools to distinguish which patients are at greatest risk for negative outcomes. We link hospital ED and medical examiner mortality databases in one state to identify individual-level risk factors associated with overdose death among ED patients with substance-related encounters. Methods: This retrospective cohort study linked Maryland statewide ED hospital claims records for adults with nonfatal overdose or substance use disorder encounters in 2014 to 2015 with medical examiner mortality records in 2015 to 2016. Logistic regression was used to identify factors in hospital records associated with risk of opioid overdose death. Predicted probabilities for overdose death were calculated for hypothetical patients with different combinations of overdose and substance use diagnostic histories. Results: A total of 139,252 patients had substance-related ED encounters in 2014 to 2015. Of these patients, 963 later experienced an opioid overdose death, indicating a case fatality rate of 69.2 per 10,000 patients, 6 times higher than that of patients who used the ED for any cause. Factors most strongly associated with death included having both an opioid and another substance use disorder (adjusted odds ratio 2.88; 95% confidence interval 2.04 to 4.07), having greater than or equal to 3 previous nonfatal overdoses (adjusted odds ratio 2.89; 95% confidence interval 1.54 to 5.43), and having a previous nonfatal overdose involving heroin (adjusted odds ratio 2.24; 95% confidence interval 1.64 to 3.05). Conclusion: These results highlight important differences in overdose risk among patients receiving care in EDs for substance-related conditions. The findings demonstrate the potential utility of incorporating routine data from patient records to assess risk of future negative outcomes and identify primary targets for initiation and linkage to lifesaving care.

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“…An examination of these patients compared with those who overdosed in other types of locations can be useful in further establishing the relative benefits of overdosing in a staffed location. Given that many who have died of an overdose had been in contact with ambulance services in the year before they died 27 , the use of ambulance data can be an important tool for exploring overdose events. Our aims were to use ambulance data as a proxy source to describe the demographic, clinical, and temporal characteristics of opioid overdoses.…”

Section: Introductionmentioning

confidence: 99%

Ambulance-Attended Opioid Overdoses: An Examination into Overdose Locations and the Role of a Safe Injection Facility

et al. 2019

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Emergency service use is common in the year before death among drug users who die from an overdose

Cited by 6 publications

References 39 publications

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

Effect of a Peer-Led Behavioral Intervention for Emergency Department Patients at High Risk of Fatal Opioid Overdose

Predictors of Overdose Death Among High-Risk Emergency Department Patients With Substance-Related Encounters: A Data Linkage Cohort Study

Ambulance-Attended Opioid Overdoses: An Examination into Overdose Locations and the Role of a Safe Injection Facility

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