From Poppy Fields to Potter's Field:
Increased Mortality after Nonfatal Heroin Overdose

by
O'Brien CS, Crandall CS, McKinney PE.
University of New Mexico: Albuquerque, NM.
Acad Emerg Med 2003 May;10(5):535-6


ABSTRACT

OBJECTIVES: To determine the follow-up mortality of patients presenting to an urban Emergency Department (ED) for nonfatal heroin overdose. METHODS: Design: Nonconcurrent prospective. Setting: Urban, university-affiliated teaching hospital. Subjects: ED charts for all 419 patients presenting to the ED 2/94-3/96 with opiate use key words (e.g., heroin, opiate, narcotic, OD, IVDA) in the chief complaint or final diagnosis fields of our ED patient database were reviewed for inclusion. ED chart review confirmed opiate overdose history and yielded 90 subjects who survived to discharge, thus comprising the cohort. Observations: Subjects were linked to state mortality files using names and date of birth. Person-time was calculated between the overdose ED visit and the date of death or end of follow-up (1/02). Persons not found in the state mortality files were presumed alive. All cause age- and gender-specific mortality rates were calculated using death data as the numerator and person-time as the denominator. The observed number of deaths was compared to the expected number using 1998 county specific age and gender mortality rates, calculating age-adjusted standardized mortality ratios (SMR). RESULTS: 16 of 90 subjects died in follow-up (10/65 male; 6/25 female), on average 2.7 years after the ED visit. The average age at death was 41.4 years. The overall mortality rate was 3,028 deaths/100,000 person-years. The annual mortality risk was 3.0% and was uniform over time. The overall SMR was 8.4 (95% CI: 5.1, 13.0). For men, the SMR was 6.0 (95% CI: 3.1, 10.6). For women, the SMR was 18.2 (95% CI: 7.8, 35.8). Most subjects died of an opiate overdose (31%), trauma (25%), or hepatitis (19%). Few (6%) died of AIDS. CONCLUSIONS: The mortality of narcotic users is striking. Effective, ED-based interventions targeting this high-risk population are urgently needed. Gender specific risks must be further studied and interventions aimed at those factors identified be prioritized.
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