Death After Detox Among Patients Without Primary Care
Inpatient detoxification may provide an important opportunity for patients, particularly those without primary care, to receive additional interventions aimed at lowering their mortality risk. To help inform such interventions, researchers in Boston assessed the rate, causes, and predictors of death among 470 participants in a randomized controlled trial that examined efforts to link patients to primary care after detoxification.
- During a mean of 4 years after detoxification, 27 (6%) subjects died. The annual age-adjusted mortality rate was 1608 per 100,000 people, 4.4 times that of the Boston population.
- Causes of death included poisoning (41% of 22 deaths with a known cause), trauma (14%), cardiovascular disease (14%), exposure to cold (9%), alcohol abuse (9%), diabetes (5%), lung cancer (5%), and intracerebral hemorrhage (5%).
- In adjusted analyses, mortality risk was significantly higher in subjects with heroin versus cocaine as their drug of choice (hazard ratio [HR], 6.9) and persistent homelessness (HR, 2.4). Risk was borderline significantly higher in subjects who had ever attempted suicide (HR, 2.1).
- Accessing primary care after detoxification did not affect mortality risk.
This study confirms an increased risk of mortality among substance users. Efforts, such as overdose prevention education, integrated housing services, and psychiatric care, that address the factors associated with this increased risk may improve the chance of survival after detoxification. This study was most likely underpowered to determine the impact of accessing primary care on mortality risk.Alexander Y. Walley, MD
Saitz R, Gaeta J, Cheng DM, et al. Risk of mortality during four years after substance detoxification in urban adults. J Urban Health. 2007;84(2):272–282.