High Mortality Among Patients with Opioid Use Disorder in General Healthcare System
- Opioid use disorder (OUD) has been identified as a national public health crisis.
- Numerous studies have shown that OUD is associated with elevated adverse health and social conditions, and elevated mortality has been observed among individuals with OUD treated in addiction specialty clinics or programs.
In light of the current effort to integrate addiction services into primary healthcare systems, information about OUD patients in general healthcare settings is needed. This study examined mortality rates, causes of death, and associated risk factors among patients with OUD in a large general healthcare system (UCLA of the former CTN Pacific Region Node).
Mortality data were linked with the electronic health records of 1,683 OUD patients cared for in the system between 2006-2014. There were 465 deaths confirmed (27.6% of the study participants), corresponding to a crude mortality rate of 68.7 per 1000 person-years.
Drug overdose and disorder (19.4%), cardiovascular diseases (16.9%), cancer (16.3%) and infectious diseases (14.5%, including 12% hepatitis C virus [HCV]) were the leading causes of death.
HCV and cannabis use disorder were the two clinically important indicators of overall mortality risk. Chronic pain and tobacco use disorder were associated with increased risk of cardiovascular death, HCV infection with cancer mortality risk, and alcohol use disorder with liver-related mortality risk.
Conclusions: Patients with OUD in a general healthcare system demonstrated alarmingly high morbidity and mortality, which challenges health care systems to find innovative ways to identify and treat patients with substance use disorder. Given the chronic, relapsing nature of OUD, and high medical and psychiatric morbidity, continued care encompassing screening, early intervention, support, and monitoring is essential.
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