Mortality Risk Factors After Treating Opioid Overdose
Introduction Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark.
Methods Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis.
Results The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period 1999–2003, and 85% (66/78) of these had cardiac arrest and died. The authors found age >50 years and overdose during the weekend significantly associated with 48-h mortality. Gender, former episodes of opioid overdose, time of the day, month or year were not significantly associated with increased mortality.
Conclusions The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk.
Opioid overdose is a serious condition that is commonly treated by prehospital emergency services. Most patients recover quickly after being ventilated and receiving an opioid antagonist, but the prognosis is influenced by the high frequency of drug abuse and poor socioeconomic status. Admission to hospital after treatment may allow careful observation but drug addicts are quite often not motivated for hospitalisation and some medical emergency systems, including ours, allow patients to be discharged immediately at the physician's discretion after a short observation period. The group of drug abusers appreciates this policy, but there is a risk of recurrence toxicity and other morbidity. We have previously described three cases of likely fatal rebound toxicity in this group of drug addicts over 10 years. In the present study, we aimed to describe short-term outcome and to identify risk factors for death within 48 h after prehospital treatment of opioid overdose in a major European city.
Abstract and Introduction
Abstract
Introduction Opioid overdose is commonly treated by prehospital emergency services and the majority of the patients are discharged immediately after treatment and a short observation period. There is a minor risk for rebound opioid toxicity and other life-threatening conditions might occur after such episodes. The authors describe the short-term outcome and identify risk factors for death within 48 h after prehospital treatment of opioid overdose in Copenhagen, the capital of Denmark.
Methods Data on all cases of opioid overdose treated by the medical emergency care unit between 1994 and 2003 were recorded prospectively. Risk factors for death within 48 h after initial medical emergency care unit contact were analysed in a multivariable logistic regression analysis.
Results The authors recorded 4762 episodes of opioid overdose, covering 1967 unique identified patients. A total of 78 patients (8.4%, 95% CI 7.0 to 10.4) died within 48 h in the period 1999–2003, and 85% (66/78) of these had cardiac arrest and died. The authors found age >50 years and overdose during the weekend significantly associated with 48-h mortality. Gender, former episodes of opioid overdose, time of the day, month or year were not significantly associated with increased mortality.
Conclusions The author found a 48-hours mortality of 8.4%. Advanced age and opioid overdose in the weekends were significant risk factors. Release on scene after treatment was associated with a very small risk.
Introduction
Opioid overdose is a serious condition that is commonly treated by prehospital emergency services. Most patients recover quickly after being ventilated and receiving an opioid antagonist, but the prognosis is influenced by the high frequency of drug abuse and poor socioeconomic status. Admission to hospital after treatment may allow careful observation but drug addicts are quite often not motivated for hospitalisation and some medical emergency systems, including ours, allow patients to be discharged immediately at the physician's discretion after a short observation period. The group of drug abusers appreciates this policy, but there is a risk of recurrence toxicity and other morbidity. We have previously described three cases of likely fatal rebound toxicity in this group of drug addicts over 10 years. In the present study, we aimed to describe short-term outcome and to identify risk factors for death within 48 h after prehospital treatment of opioid overdose in a major European city.
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