Prescription Painkillers Implicated in Most Overdose Admissions

Roughly two-thirds of emergency department admissions for overdoses involve prescription opioid medications, according to a research letter published online today by JAMA Internal Medicine.

Noting that opioid overdoses are a leading cause of injury-related mortality in the United States, yet little is known on how they present in US hospitals, a team of researchers analyzed the 2010 Nationwide Emergency Department Sample, through which they identified 135,971 visits with diagnostic codes for opioid overdose.

Of those overdose-related emergency department visits, 67.8% involved prescription opioids, including methadone, while 16.1% involved heroin, 13.4% involved unspecified opioids, and 2.7% involved multiple opioid types.

Although the proportion of visits that resulted in death was highest for overdoses involving multiple opioids, the overall inpatient mortality rate was low—a finding the researchers attributed to the efficacy of targeted medical interventions for overdoses, such as naloxone injections.

“In our opinion, these findings support efforts to increase the use of emergency medical services for overdoses, such as Good Samaritan laws that grant limited immunity for drug-related charges to those who call 911 during an overdose,” the authors wrote.

The researchers also identified high rates of chronic mental (33.9%), circulatory (29.1%), and respiratory (25.6%) diseases among patients who presented with prescription opioid overdose, which “suggests that health care providers who prescribe opioid analgesics to patients with these comorbidities should do so with care and counsel all patients about the risk for overdose,” they noted. In addition, the researchers observed geographical variation in overdose patterns, with the greatest proportion of prescription opioid overdoses occurring in urban areas (84.1%) and in the South (40.2%).

“Most patients in our sample overdosed on prescription opioids, suggesting that further efforts to stem the prescription opioid overdose epidemic are urgently needed,” the researchers concluded. “Differences among patients presenting to [emergency departments] with opioid overdose have important implications for clinical- and population-level overdose prevention efforts.”