Causes of Death Among Patients With Opioid Use Disorder in a General Medical Setting

Most mortality and morbidity data on opioid use disorder (OUD) have come from publicly funded treatment center and population-level sources. In this study, researchers assessed all-cause and cause-specific mortality in 2576 patients aged 18 to 64 years with OUD. Patients were identified via ICD-9 codes from inpatient and outpatient visits to a large US university health system from 2006 to 2014. Mortality data were obtained through the National Death Index.

• Overall, 18% of patients died. Among decedents, the causes of death were drug or substance related (20%), drug or substance poisoning (17%), cardiovascular (17%), cancer (17%), infectious (14%), hepatitis C (12%), digestive system (12%), and liver disease (11%).
• The overall crude mortality rate was 48.6 per 1000 person-years and standardized mortality rate was 10.3 per 1000 person-years.
• Age, hepatitis C infection, and alcohol use disorder were associated with significantly higher risk of all-cause mortality among those with OUD.

Comments: The crude all-cause mortality rate in this sample is much higher than prior reports (e.g., 20.9 per 1000 person-years in one large systematic review and meta-analysis of 58 cohort studies), perhaps because the sample was drawn from a healthcare setting. A significant proportion (37%) of the deaths were directly related to substances. Although recorded ICD-9 codes for OUD may not always be accurate, the study reiterates the need for providers and health systems to improve efficient identification of OUD, provision of naloxone, and timely treatment for these patients.

Kevin L. Kraemer, MD, MSc

Reference: Hser YI, Mooney LJ, Saxon AJ, et al. High mortality among patients with opioid use disorder in a large healthcare system. J Addict Med. 2017;11(4):315–319.