Ruchir N Karmali1, G Thomas Ray2, Andrea L Rubinstein3, Stacy A Sterling4, Constance M Weisner5, Cynthia I Campbell6. 1. Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States. Electronic address: Ruchir.N.Karmali@kp.org. 2. Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States. Electronic address: Tom.Ray@kp.org. 3. Kaiser Permanente Santa Rosa Medical Center, 3559 Round Barn Blvd, Santa Rosa, CA 95403, United States. Electronic address: Andrea.L.Rubinstein@kp.org. 4. Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States. Electronic address: Stacy.A.Sterling@kp.org. 5. Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States. Electronic address: Constance.Weisner@kp.org. 6. Kaiser Permanente Northern California, Division of Research, 2000 Broadway, Oakland, CA 94612, United States. Electronic address: Cynthia.I.Campbell@kp.org.
Abstract
BACKGROUND: A non-fatal opioid overdose (NFOO) increases the risk of another overdose and identifies high-risk patients. We estimated the risk of repeat opioid overdose for patients with and without substance use disorder (SUD) diagnoses and the change in substance use treatment utilization rates associated with the first NFOO. METHODS: We selected patients (>18 years of age) from Kaiser Permanente Northern California with a NFOO between 2009-2016 (n = 3,992). Cox proportional hazards models estimated the 1-year risk of opioid overdose associated with SUD diagnoses (opioid, alcohol, cannabis, amphetamine, sedative, and cocaine), controlling for patient characteristics. Among patients with an index NFOO, we calculated monthly utilization rates for outpatient substance use services and buprenorphine before and after the index overdose. Interrupted time series models estimated the change in level and trend in utilization rates associated with the index overdose. RESULTS: Approximately 7.2 % of patients had a repeat opioid overdose during the year after the index NFOO. The only SUD diagnosis significantly associated with greater risk of repeat overdose was opioid use disorder (OUD) (aHR: 1.51; 95 % CI: 1.13-2.01). Before the index overdose, 4.16 % of patients received outpatient substance use services and 1.32 % received buprenorphine. The index overdose was associated with a 5.94 % (standard error: 0.77 %) absolute increase in outpatient substance use services and a 1.29 % (standard error: 0.15 %) increase in buprenorphine. CONCLUSION: Patients with a NFOO and OUD are vulnerable to another overdose. Low initiation rates for substance use treatment after a NFOO indicate a need to address patient, provider, and system barriers.
BACKGROUND: A non-fatal opioid overdose (NFOO) increases the risk of another overdose and identifies high-risk patients. We estimated the risk of repeat opioid overdose for patients with and without substance use disorder (SUD) diagnoses and the change in substance use treatment utilization rates associated with the first NFOO. METHODS: We selected patients (>18 years of age) from Kaiser Permanente Northern California with a NFOO between 2009-2016 (n = 3,992). Cox proportional hazards models estimated the 1-year risk of opioid overdose associated with SUD diagnoses (opioid, alcohol, cannabis, amphetamine, sedative, and cocaine), controlling for patient characteristics. Among patients with an index NFOO, we calculated monthly utilization rates for outpatient substance use services and buprenorphine before and after the index overdose. Interrupted time series models estimated the change in level and trend in utilization rates associated with the index overdose. RESULTS: Approximately 7.2 % of patients had a repeat opioid overdose during the year after the index NFOO. The only SUD diagnosis significantly associated with greater risk of repeat overdose was opioid use disorder (OUD) (aHR: 1.51; 95 % CI: 1.13-2.01). Before the index overdose, 4.16 % of patients received outpatient substance use services and 1.32 % received buprenorphine. The index overdose was associated with a 5.94 % (standard error: 0.77 %) absolute increase in outpatient substance use services and a 1.29 % (standard error: 0.15 %) increase in buprenorphine. CONCLUSION:Patients with a NFOO and OUD are vulnerable to another overdose. Low initiation rates for substance use treatment after a NFOO indicate a need to address patient, provider, and system barriers.
Authors: Shane R Mueller; Stephen Koester; Jason M Glanz; Edward M Gardner; Ingrid A Binswanger Journal: J Gen Intern Med Date: 2016-10-31 Impact factor: 5.128
Authors: Marc R Larochelle; Jane M Liebschutz; Fang Zhang; Dennis Ross-Degnan; J Frank Wharam Journal: Ann Intern Med Date: 2015-12-29 Impact factor: 25.391
Authors: Julie E Richards; Jennifer F Bobb; Amy K Lee; Gwen T Lapham; Emily C Williams; Joseph E Glass; Evette J Ludman; Carol Achtmeyer; Ryan M Caldeiro; Malia Oliver; Katharine A Bradley Journal: Drug Alcohol Depend Date: 2019-06-08 Impact factor: 4.492
Authors: Shabbar I Ranapurwala; Rebecca B Naumann; Anna E Austin; Nabarun Dasgupta; Stephen W Marshall Journal: Pharmacoepidemiol Drug Saf Date: 2018-06-03 Impact factor: 2.890
Authors: Stephen Crystal; Molly Nowels; Hillary Samples; Mark Olfson; Arthur Robin Williams; Peter Treitler Journal: Drug Alcohol Depend Date: 2022-01-10 Impact factor: 4.492
Authors: Niranjan S Karnik; John Marsden; Connor McCluskey; Randy A Boley; Katharine A Bradley; Cynthia I Campbell; Megan E Curtis; David Fiellin; Udi Ghitza; Kathryn Hefner; Yih-Ing Hser; R Kathryn McHugh; Sterling M McPherson; Larissa J Mooney; Landhing M Moran; Sean M Murphy; Robert P Schwartz; Dikla Shmueli-Blumberg; Matisyahu Shulman; Kari A Stephens; Katherine E Watkins; Roger D Weiss; Li-Tzy Wu Journal: Addiction Date: 2022-04-25 Impact factor: 7.256