Overdose risk may be highest in week after hospital discharge for patients on long-term opioids

During the first seven days after hospital discharge, patients prescribed long-term opioid therapy overdosed on opioids at a rate six times higher than in other time periods, a retrospective study in one health system found.

Patients who are on long-term opioids may be at highest risk for overdose in the week after hospital discharge, a retrospective study found.

Researchers identified adults who were prescribed long-term opioid therapy and had at least one discharge from January 2006 through June 2019 at a safety-net health system and a nonprofit health care organization in Colorado. The primary outcome was a composite of fatal and nonfatal opioid overdoses during a 90-day postdischarge observation period. The researchers used a risk interval analysis to compare rates of opioid overdose, with individuals serving as their own controls in predefined intervals of risk (days 0 to 6 after hospital discharges) and control (days 7 to 89 after index discharge and all other time during the observation period when patients were not admitted or in a risk interval). Results were published Jan. 25 by the Journal of General Internal Medicine.

A total of 7,695 adults (63.3% >age 55 years; 59.4% female; 20.3% Hispanic) had 9,499 total discharges during the study period. During their observation periods, 21 overdoses occurred (1,174 per 100,000 person-years), nine in the risk interval and 12 in the control interval. Estimated overdose risk was significantly higher during the risk interval compared with the control interval (incidence rate ratio [IRR], 6.92; 95% CI, 2.92 to 16.43). Similarly, secondary analyses that looked at days 0 to 13 and 0 to 29 after discharge showed an elevated risk of overdose compared to the control interval (IRRs, 3.89 [95% CI, 1.65 to 9.16] and 4.00 [95% CI, 1.55 to 10.32], respectively).

Overdose events were rare, and the confidence intervals associated with the estimates were wide, the study authors noted. “Even so, the lower limit of our confidence interval for our primary analysis suggests nearly a 3-fold higher risk of opioid overdose in the 7-day post-discharge time period, a clinically relevant and statistically significant result. … Future work is needed to better understand the mechanisms underlying this risk, and whether and how in-hospital and post-discharge clinical management might influence that risk,” they wrote.