The role of substance use disorders in experiencing a repeat opioid overdose, and substance use treatment patterns among patients with a non-fatal opioid overdose

Prevalence of Mental Health Disorders among Individuals Enrolled in an Emergency Response Program for Treatment of Opioid Use Disorder

“… 15 Our study of high-risk persons with OUD confirmed high rates (93%) of polysubstance use, with 63.7% of participants using 5 or more substances. Similarly, our study showed much higher alcohol use (96%) among individuals with OUD than other studies, which have reported between 18.8% 64 and 29%; 32 and also, higher marijuana use (87%) whereas other studies have shown between 9% 64 and 16%. 32 Finally, a significant portion of our participants reported using methamphetamines (60%) compared to 7% 32 and hallucinogens (63%) compared to <1%.…”

“… 32 Finally, a significant portion of our participants reported using methamphetamines (60%) compared to 7% 32 and hallucinogens (63%) compared to <1%. 64 Other research has reported nicotine use at between 29% 64 and 42%, 32 whereas 85% of our study participants reported nicotine use. Overall, the participants in our study were at-risk across multiple domains including their social, behavioral, and physical environments, with 80% having no form of health insurance, and approximately two-thirds were homeless or in temporary or unstable housing.…”

Mental disorder and opioid overdose: a systematic review

“…A connection between depression and overdose was also present in studies of commercially insured adolescents (AHR 2.77, 95% CI 2.26-3.34 [62]), pregnant/postpartum women (depression prevalence with overdose 84.8% vs. opioid use disorder 61.2% vs. neither 18.9%, p < 0.001 [59], and Veterans Health Administration claims (56.4% vs. 36.7%, p < 0.0001 [46]. Non-significant findings or findings that did not retain significance in multivariable analysis include those from a study with Veterans Health Administration patients [64], those eligible for Medicaid in Oklahoma [34],the general population of US adults [31], repeat overdose events [49,58],commercially insured individuals [55], and young people who use heroin in Australia [39].…”

“…Those with anxiety disorders were more likely to experience opioid overdose in Ontario (cases 63.2% vs. controls 54.9%, standardized difference = 0.13; [38]), in British Columbia (men: 30.0% vs. 6.8%, p < 0.01; women: 45.0% vs. 11.0%, p < 0.01; [60]), and in people presenting to an emergency department in Pennsylvania (repeat overdose AHR 1.41, 95% CI 1.13-1.77; [63]). These association were also seen in two national samples of the Medicare enrollee population (adjusted OR 1.26, 95% CI 1.07-1.48) [53] (63.4% vs. 30.9%) [32], as well as the commercially insured population in four studies: three with adult populations (AOR (95% CI) 1.64 (1.50-1.80) [48]), AOR 1.24, 95% CI 1.12-1.36 [55], repeat overdose events for those with anxiety 39.5% vs. 47.0%, p = 0.013 [58]), and one with adolescents (prescription opioid overdose AHR 1.65, 95% CI 1.33-2.06; [62]). Other samples where this relationship was seen include those with substance use disorder in New South Wales (non-fatal overdose and suicide attempt AOR 1.71, 95% CI 1.17-2.51, p < 0.05 3 ,association not present in subgroup analysis [47]),among Veterans Health Administration claims (anxiety in those with overdose 22.3% vs. nonopioid related hospitalizations 15.1%, p < 0.05 4 ; [46], and in a cohort of pregnant/postpartum women (prevalence of anxiety among those with overdose 82.1% vs. opioid use disorder 60.2%, vs. neither 18.3% p < 0.001 [59].…”

“…Bipolar disorder was associated with overdose in an Australian study of people with substance use disorder (OR 3.37, 95% CI 1.44-7.88) [15], in commercially insured (OR 2.18, 95% CI 1.83-2.60) [48] and veteran populations prescribed opioids in the US,(OR 1.68, 95% CI 1.17-2.43) [48], and for females (ARR 1.05, 95% CI 1.00-1.12, p < 0.05) but not males who were prescribed opioids [50]. Those who experienced overdose were more likely to have bipolar disorder than controls when measured: in a cohort of Medicare enrollees across the US (AOR 1.51, 95% CI 1.28-1.79) [32], among members of Oklahoma's Medicaid program (AOR 1.78, 95% CI 1.20-2.65) [34], in patients of the Veterans Health Administration (AOR 1.7, 95% CI 1.2-2.4, p = 0.005) [64], among patients with repeat overdose in California (22.3% vs. 14.8%, p < 0.001) [58], in those with both opioid overdose and suicide attempt in New South Whales (AOR 2.29, 95% CI 1.55-3.34, p < 0.001 8 [47]), and in both men (past year disorder 6.3% vs. 0.82%, p < 0.01) and women (11% vs. 1%, p < 0.01) in British Columbia [60]. A multivariable analysis on a retrospective cohort of persons with non-fatal opioid overdose in Pennsylvania did not find a significant association with bipolar disorder [63].…”