- The number of opioid overdoses requiring admission to intensive care has skyrocketed by more than a third since 2009, bringing higher death rates and significantly more spending on high-intensity hospital care, according to a new study from the Annals of the American Thoracic Society.
Between January 2009 and September 2015, the number of opioid overdoses requiring ICU admission increased nationally from 44 per 10,000 patients to 59 per 10,000 patients, found a team of authors from Beth Israel Deaconess Medical Center, the University of Chicago, and Ben-Gurion University of the Negev in Israel.
The study of more than 22 million American patients receiving ICU care in 44 states also found that deaths of overdose patients admitted to the ICU increased alongside the admission rate, jumping from 7 percent in 2009 to 10 percent by the end of the study period.
The costs of caring for these patients also rose dramatically, from an average of around $58,000 in 2009 to $92,400 in 2015, adjusted for inflation. This represents a 58 percent increase in spending per patient.
"The opioid epidemic has reached a new level of crisis," said lead study author Jennifer P. Stevens, MD, associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School.
"This study tells us that the opioid epidemic has made people sicker and killed more people, in spite of all the care we can provide in the ICU, including mechanical ventilation, acute dialysis, life support and round-the-clock care."
Source: Annals of the American Thoracic Society
While much of the national discussion on opioid overdoses has focused on first responders’ efforts to administer naloxone in the field, many patients subsequently require hospitalization and high-acuity intensive care to mitigate complications arising from improper substance use.
"These data don't tell us whether the problem is with the drugs themselves, challenges with pre-hospital care for patients with overdose, our care in the ICUs or some combination of these factors," noted Stevens.
"The urgency of our findings, however, suggests the need for a larger, national approach to developing safe strategies to care for patients with overdose in the ICU, to provide coordinated resources in the hospital for patients and families and to help survivors maintain sobriety on discharge."
A quarter of the overdose patients receiving ICU care experienced aspiration pneumonia, while 15 percent were diagnosed with rhabdomyolosis. Eight percent experienced anoxic brain injury and six percent suffered from septic shock.
Ten percent of all opioid-related ICU patients required mechanical ventilation, the study added, while the population also required renal replacement therapy 37 percent more often in 2015 than in 2009.
The steady increase in the number and severity of opioid-related ICU admission – many of which were due to heroin use instead of prescription drug abuse – followed certain geographical patterns.
Source: Annals of the American Thoracic Society
Eight states included more than five hospitals with significant numbers of overdose patients.
Massachusetts and Indiana received the unenviable distinction of having the two highest opioid admission densities in the nation, while Pennsylvania experienced the sharpest rise in opioid-related overdoses during the study period.
Critical care admissions for overdose have nearly doubled in the Keystone State since 2009, the researchers found. Indiana and Massachusetts, as well as Illinois, California, and New York, have also experienced notable upticks in ICU admission rates over the past few years.
“Early recognition for states with rising crises – such as Pennsylvania – may allow for early action in these areas to both prepare critical care units for the needs of this population and to better equip front line providers to prevent these critical care admissions from occurring,” the study suggests.
The researchers conclude with a caution that their estimates may actually be on the low side. Because the study analyzed administrative and claims data instead of using manual chart review, the team may not have captured every admission due to opioid-related complications that were not specifically coded as such.
The study also focused on data sources that primarily include medical centers in more urban areas, which may not be generalizable to more rural settings.
“Our findings are agnostic as to whether local community emergency response teams are doing better at rescuing people with overdoses (leading to more ICU admissions due to higher numbers of patients surviving) or whether this represents an opportunity for improvement (if more immediate care had been available, patients may have required lower-levels of care rather than the ICU),” the report adds.
“Any admission to the ICU for opioid overdose is a preventable admission. If each of these admissions are preventable and, by extension, the growing number of deaths from overdoses are also preventable, we would suggest that these findings represent a growing and urgent call for additional critical care resources and expanded primary prevention strategies.”