Mortality Due to Comorbidities Following Nonfatal Opioid Overdose

Increases in opioid overdose deaths in the United States are well documented. However, the mortality and morbidity associated with opioids extend well beyond overdose deaths. This study used a national Medicaid sample of 76,325 individuals surviving an opioid overdose between 2001 and 2007 and identified cause-specific standardized mortality rate ratios (SMRs), standardizing to the general population by age, sex, and race/ethnicity.

• The crude mortality rate was 778 per 100,000 person-years, and all-cause SMR was 24.
• SMRs were elevated for several causes in the year following overdose, including: suicide (SMR, 24); HIV (SMR, 46); viral hepatitis (SMR, 31); influenza and pneumonia (SMR, 24); cirrhosis and alcohol-related liver disease (SMR, 16); and cancer (SMR, 9).

Comments: Although dated, these results demonstrate that opioid overdose survivors have mortality attributable to myriad causes beyond overdose, including mental health, infectious diseases, liver disease, and malignancy. Care for individuals with severe opioid use disorder should address both the substance use disorder and associated comorbidities. These results support the need for Medicaid expansion as funding for substance use treatment and adequate coverage to treat associated comorbidities.

Marc R. Larochelle, MD, MPH

Reference: Olfson M, Crystal S, Wall M, et al. Causes of death after nonfatal opioid overdose. JAMA Psychiatry. 2018;75(8):820–827.