Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis
Background Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown. Objective To examine the association between time since hospital discharge...
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| Veröffentlicht in: | Journal of general internal medicine : JGIM 2023-08, Vol.38 (11), p.2560-2567 |
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| creator | Lyden, Jennifer R. Xu, Stanley Narwaney, Komal J. Glanz, Jason M. Binswanger, Ingrid A. |
| description | Background
Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown.
Objective
To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT.
Design
Self-controlled risk interval analysis.
Participants
Adults prescribed LTOT with at least one hospital discharge at a safety-net health system and a non-profit healthcare organization in Colorado.
Main Measures
We identified individuals prescribed LTOT who were discharged from January 2006 through June 2019. The outcome was a composite of fatal and non-fatal opioid overdoses during a 90-day post-discharge observation period, identified using electronic health record (EHR) and vital statistics data. Risk intervals included days 0–6 after index and subsequent hospital discharges. Control intervals ranged from days 7 to 89 after index discharge and included all other time during the observation period that did not fall within a risk interval or time readmitted during a subsequent hospitalization, which was excluded. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for overdose events during risk in comparison to control intervals.
Key Results
We identified 7695 adults (63.3% over 55 years, 59.4% female, 20.3% Hispanic) who experienced 9499 total discharges during the study period. Twenty-one overdoses occurred during their observation periods (1174 per 100,000 person-years [9 in risk, 12 in control]). Overdose risk was significantly higher during the risk interval in comparison to the control interval (IRR 6.92; 95% CI 2.92–16.43).
Conclusion
During the first 7 days after hospital discharge, individuals prescribed LTOT appear to be at elevated risk for opioid overdose. Clarifying mechanisms of overdose risk may help inform in-hospital and post-discharge prevention strategies. |
| doi_str_mv | 10.1007/s11606-022-08014-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9876414</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2858505943</sourcerecordid><originalsourceid>FETCH-LOGICAL-c425t-93334b778a7591b939ffcefa62299c812288267b1f8a1d94713b0ce80123a9353</originalsourceid><addsrcrecordid>eNp9kU9v0zAYxi0EYmXwBTggS1y4GPwv_sMBqRqMVapUhMrZchKn9UjiYCdFPfLN8ZYyNg6cfHh-_tnv-wDwkuC3BGP5LhEisECYUoQVJhyRR2BBClogwrV8DBZYKY6UZPwMPEvpGmPCKFVPwRkTQkvN8AL82gw--BpuDi7WITn41afv8DK0bfjp-x28Cmnwo23hR5-qvY07B5ddyMGqr_3B15NtE_wSXaqiL10N1zlDWxc7eBJv9y7a4fge2lm96kcXD1m47G17TD49B0-aLHEvTuc5-Hb5aXtxhdabz6uL5RpVnBYj0owxXkqprCw0KTXTTVO5xgpKta4UyYMpKmRJGmVJrbkkrMSVy3uhzGpWsHPwYfYOU9m5unL9GG1rhug7G48mWG8eJr3fm104GK2k4IRnwZuTIIYfk0uj6fJOXNva3oUpGSqF1lpwJTL6-h_0OkwxD5wpVagCF5qzTNGZqmJIKbrm7jMEm5uGzdywyQ2b24YNyZde3R_j7sqfSjPAZiDlqN-5-Pft_2h_Axjcsig</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2858505943</pqid></control><display><type>article</type><title>Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis</title><source>Springer Nature - Complete Springer Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><source>Alma/SFX Local Collection</source><creator>Lyden, Jennifer R. ; Xu, Stanley ; Narwaney, Komal J. ; Glanz, Jason M. ; Binswanger, Ingrid A.</creator><creatorcontrib>Lyden, Jennifer R. ; Xu, Stanley ; Narwaney, Komal J. ; Glanz, Jason M. ; Binswanger, Ingrid A.</creatorcontrib><description>Background
Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown.
Objective
To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT.
Design
Self-controlled risk interval analysis.
Participants
Adults prescribed LTOT with at least one hospital discharge at a safety-net health system and a non-profit healthcare organization in Colorado.
Main Measures
We identified individuals prescribed LTOT who were discharged from January 2006 through June 2019. The outcome was a composite of fatal and non-fatal opioid overdoses during a 90-day post-discharge observation period, identified using electronic health record (EHR) and vital statistics data. Risk intervals included days 0–6 after index and subsequent hospital discharges. Control intervals ranged from days 7 to 89 after index discharge and included all other time during the observation period that did not fall within a risk interval or time readmitted during a subsequent hospitalization, which was excluded. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for overdose events during risk in comparison to control intervals.
Key Results
We identified 7695 adults (63.3% over 55 years, 59.4% female, 20.3% Hispanic) who experienced 9499 total discharges during the study period. Twenty-one overdoses occurred during their observation periods (1174 per 100,000 person-years [9 in risk, 12 in control]). Overdose risk was significantly higher during the risk interval in comparison to the control interval (IRR 6.92; 95% CI 2.92–16.43).
Conclusion
During the first 7 days after hospital discharge, individuals prescribed LTOT appear to be at elevated risk for opioid overdose. Clarifying mechanisms of overdose risk may help inform in-hospital and post-discharge prevention strategies.</description><identifier>ISSN: 0884-8734</identifier><identifier>EISSN: 1525-1497</identifier><identifier>DOI: 10.1007/s11606-022-08014-1</identifier><identifier>PMID: 36697930</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adults ; Confidence intervals ; Drug overdose ; Electronic health records ; Electronic medical records ; Hospitals ; Internal Medicine ; Medicine ; Medicine & Public Health ; Narcotics ; Opioids ; Original Research ; Overdose ; Risk analysis ; Risk management ; Statistical analysis ; Vital statistics</subject><ispartof>Journal of general internal medicine : JGIM, 2023-08, Vol.38 (11), p.2560-2567</ispartof><rights>The Author(s), under exclusive licence to Society of General Internal Medicine 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Society of General Internal Medicine.</rights><rights>The Author(s), under exclusive licence to Society of General Internal Medicine 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c425t-93334b778a7591b939ffcefa62299c812288267b1f8a1d94713b0ce80123a9353</cites><orcidid>0000-0001-8403-9815</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9876414/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9876414/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,41467,42536,51297,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36697930$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lyden, Jennifer R.</creatorcontrib><creatorcontrib>Xu, Stanley</creatorcontrib><creatorcontrib>Narwaney, Komal J.</creatorcontrib><creatorcontrib>Glanz, Jason M.</creatorcontrib><creatorcontrib>Binswanger, Ingrid A.</creatorcontrib><title>Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis</title><title>Journal of general internal medicine : JGIM</title><addtitle>J GEN INTERN MED</addtitle><addtitle>J Gen Intern Med</addtitle><description>Background
Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown.
Objective
To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT.
Design
Self-controlled risk interval analysis.
Participants
Adults prescribed LTOT with at least one hospital discharge at a safety-net health system and a non-profit healthcare organization in Colorado.
Main Measures
We identified individuals prescribed LTOT who were discharged from January 2006 through June 2019. The outcome was a composite of fatal and non-fatal opioid overdoses during a 90-day post-discharge observation period, identified using electronic health record (EHR) and vital statistics data. Risk intervals included days 0–6 after index and subsequent hospital discharges. Control intervals ranged from days 7 to 89 after index discharge and included all other time during the observation period that did not fall within a risk interval or time readmitted during a subsequent hospitalization, which was excluded. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for overdose events during risk in comparison to control intervals.
Key Results
We identified 7695 adults (63.3% over 55 years, 59.4% female, 20.3% Hispanic) who experienced 9499 total discharges during the study period. Twenty-one overdoses occurred during their observation periods (1174 per 100,000 person-years [9 in risk, 12 in control]). Overdose risk was significantly higher during the risk interval in comparison to the control interval (IRR 6.92; 95% CI 2.92–16.43).
Conclusion
During the first 7 days after hospital discharge, individuals prescribed LTOT appear to be at elevated risk for opioid overdose. Clarifying mechanisms of overdose risk may help inform in-hospital and post-discharge prevention strategies.</description><subject>Adults</subject><subject>Confidence intervals</subject><subject>Drug overdose</subject><subject>Electronic health records</subject><subject>Electronic medical records</subject><subject>Hospitals</subject><subject>Internal Medicine</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Original Research</subject><subject>Overdose</subject><subject>Risk analysis</subject><subject>Risk management</subject><subject>Statistical analysis</subject><subject>Vital statistics</subject><issn>0884-8734</issn><issn>1525-1497</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNp9kU9v0zAYxi0EYmXwBTggS1y4GPwv_sMBqRqMVapUhMrZchKn9UjiYCdFPfLN8ZYyNg6cfHh-_tnv-wDwkuC3BGP5LhEisECYUoQVJhyRR2BBClogwrV8DBZYKY6UZPwMPEvpGmPCKFVPwRkTQkvN8AL82gw--BpuDi7WITn41afv8DK0bfjp-x28Cmnwo23hR5-qvY07B5ddyMGqr_3B15NtE_wSXaqiL10N1zlDWxc7eBJv9y7a4fge2lm96kcXD1m47G17TD49B0-aLHEvTuc5-Hb5aXtxhdabz6uL5RpVnBYj0owxXkqprCw0KTXTTVO5xgpKta4UyYMpKmRJGmVJrbkkrMSVy3uhzGpWsHPwYfYOU9m5unL9GG1rhug7G48mWG8eJr3fm104GK2k4IRnwZuTIIYfk0uj6fJOXNva3oUpGSqF1lpwJTL6-h_0OkwxD5wpVagCF5qzTNGZqmJIKbrm7jMEm5uGzdywyQ2b24YNyZde3R_j7sqfSjPAZiDlqN-5-Pft_2h_Axjcsig</recordid><startdate>20230801</startdate><enddate>20230801</enddate><creator>Lyden, Jennifer R.</creator><creator>Xu, Stanley</creator><creator>Narwaney, Komal J.</creator><creator>Glanz, Jason M.</creator><creator>Binswanger, Ingrid A.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-8403-9815</orcidid></search><sort><creationdate>20230801</creationdate><title>Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis</title><author>Lyden, Jennifer R. ; Xu, Stanley ; Narwaney, Komal J. ; Glanz, Jason M. ; Binswanger, Ingrid A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-93334b778a7591b939ffcefa62299c812288267b1f8a1d94713b0ce80123a9353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adults</topic><topic>Confidence intervals</topic><topic>Drug overdose</topic><topic>Electronic health records</topic><topic>Electronic medical records</topic><topic>Hospitals</topic><topic>Internal Medicine</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Original Research</topic><topic>Overdose</topic><topic>Risk analysis</topic><topic>Risk management</topic><topic>Statistical analysis</topic><topic>Vital statistics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lyden, Jennifer R.</creatorcontrib><creatorcontrib>Xu, Stanley</creatorcontrib><creatorcontrib>Narwaney, Komal J.</creatorcontrib><creatorcontrib>Glanz, Jason M.</creatorcontrib><creatorcontrib>Binswanger, Ingrid A.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of general internal medicine : JGIM</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lyden, Jennifer R.</au><au>Xu, Stanley</au><au>Narwaney, Komal J.</au><au>Glanz, Jason M.</au><au>Binswanger, Ingrid A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis</atitle><jtitle>Journal of general internal medicine : JGIM</jtitle><stitle>J GEN INTERN MED</stitle><addtitle>J Gen Intern Med</addtitle><date>2023-08-01</date><risdate>2023</risdate><volume>38</volume><issue>11</issue><spage>2560</spage><epage>2567</epage><pages>2560-2567</pages><issn>0884-8734</issn><eissn>1525-1497</eissn><abstract>Background
Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown.
Objective
To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT.
Design
Self-controlled risk interval analysis.
Participants
Adults prescribed LTOT with at least one hospital discharge at a safety-net health system and a non-profit healthcare organization in Colorado.
Main Measures
We identified individuals prescribed LTOT who were discharged from January 2006 through June 2019. The outcome was a composite of fatal and non-fatal opioid overdoses during a 90-day post-discharge observation period, identified using electronic health record (EHR) and vital statistics data. Risk intervals included days 0–6 after index and subsequent hospital discharges. Control intervals ranged from days 7 to 89 after index discharge and included all other time during the observation period that did not fall within a risk interval or time readmitted during a subsequent hospitalization, which was excluded. Poisson regression was used to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) for overdose events during risk in comparison to control intervals.
Key Results
We identified 7695 adults (63.3% over 55 years, 59.4% female, 20.3% Hispanic) who experienced 9499 total discharges during the study period. Twenty-one overdoses occurred during their observation periods (1174 per 100,000 person-years [9 in risk, 12 in control]). Overdose risk was significantly higher during the risk interval in comparison to the control interval (IRR 6.92; 95% CI 2.92–16.43).
Conclusion
During the first 7 days after hospital discharge, individuals prescribed LTOT appear to be at elevated risk for opioid overdose. Clarifying mechanisms of overdose risk may help inform in-hospital and post-discharge prevention strategies.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>36697930</pmid><doi>10.1007/s11606-022-08014-1</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-8403-9815</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Adults Confidence intervals Drug overdose Electronic health records Electronic medical records Hospitals Internal Medicine Medicine Medicine & Public Health Narcotics Opioids Original Research Overdose Risk analysis Risk management Statistical analysis Vital statistics |
| title | Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis |
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