People who are addicted to opioids and receiving their medical care in a general health care setting were more than 10 times as likely to die during a 4-year period than people without substance abuse problems, according to a study published in the Journal of Addiction Medicine.
The findings suggest that healthcare systems should have better infrastructure and training for primary care physicians to diagnose and treat opioid use disorder.
The study is the first to look at the mortality rate of people with opioid use disorder in a general healthcare system rather than those treated at specialty addiction clinics. The mortality rate among patients in this setting, which includes primary care offices and large research hospitals, was more than 2 times higher than what previous studies had found in specialty clinics.
“The high rates of death among patients with opioid use disorder in a general healthcare system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” said Yih-Ing Hser, MD, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
The number of opioid overdoses in the United States has quadrupled since 1999, leading some physicians and policymakers to declare the opioid problem a national crisis. As rates of opioid addiction have risen, patients with opioid abuse problems increasingly are being treated by generalists, such as internists and primary care physicians, in doctors’ offices. Until now, researchers had not gauged the impact of this influx of patients with opioid abuse and addiction in primary care settings.
For the current study, the researchers analysed electronic health records, and an associated death index system, for 2,576 patients, aged 18 to 64 years, diagnosed with opioid use disorder from 2006 to 2014. The individuals received healthcare at a major university hospital system. While all of those studied had diagnoses of opioid use disorder, not all were receiving treatment for it.
By the end of the study period, 465 people (18.1% of the study population) had died. Based on how long each person had participated in the study — an average of about 4 years for each individual — the researchers calculated a crude mortality rate of 48.6 deaths per 1,000 person-years — more than 2 times higher than the 20.9 deaths per 1,000 reported in previous studies done in specialty addiction clinics. The rate was also more than 10 times higher than the expected death rate for people of the same age and sex in the general US population.
Overall, the patients in the new study were older at diagnosis and had a higher rate of other diseases and disorders compared with patients included in previous studies that took place at specialty clinics. The researchers noted higher rates of both simultaneously occurring health complications — including hepatitis C, liver disease, cardiovascular disease, cancer, and diabetes — as well as other substance abuse disorders involving tobacco, alcohol, cannabis and cocaine — among the patients who died.
“The findings were surprising because one would potentially expect better healthcare outcomes for patients being served by a large healthcare system,” said Dr. Hser said. “Late identification of opioid use disorder and lack of addiction treatment could contribute to these high rates of serious health conditions and death.”
Black or uninsured individuals were also more likely to die during the study period, the researchers said, a finding they noted highlights the need for additional research on disparities in addiction care.
Additional research will be needed, they concluded, to determine how to best curb the mortality rates among all individuals with opioid use disorder and better integrate substance abuse disorder screening and treatment into primary care.