Drug-related deaths are four times more likely to occur in the two days after hospital discharge than at any other time among users of opioids such as heroin or illicitly sought prescription opioids not directly prescribed for the consumer, according to research led by UCL, Public Health England (PHE) and King’s College London.
The peer-reviewed study, published today in PLOS Medicine, looked at data from 13,609 adults in England, who were aged between 18 and 64 years old, and died after using non-prescribed opioids over a nine year period between 2010 and 2019.
The researchers looked at the history of individuals’ hospital admissions and then assessed whether they were admitted to hospital at the time of death, or had recently been discharged. Overall, the study found that 1 in 14 opioid-related deaths in England occurred within the first two weeks after being discharged from hospital.
Of the 13,609 deaths, 1,088 occurred within the 14 days after hospital discharge, particularly during the first 48 hours, when the risk of fatal overdose is four times higher than usual as their tolerance has dropped since being admitted into hospital. Patients who’re admitted to mental health in-patient hospitals, who self discharged and left hospital against their doctor’s advice, or who had stays of seven days or more were also at greater risk more the reason mentioned before, or because of other contributing factors.
Deaths due to drug overdoses reached the highest level on record in the UK in 2020, and it’s concerning to see that hospital discharge is such a high-risk time for people who use illicit opioids such as heroin.
Lead author, Dan Lewer (UCL Institute of Epidemiology and Health Care and NIHR Research Fellow)
Hospital patients who use drugs often report under-treated pain or opioid withdrawal and might leave hospital sooner than medically recommended by their treating clinician to use illegal drugs. More support is urgently needed for those leaving hospital, and interventions such as medication assisted treatments (MAT) or other psycho-therapeutic treatments to prevent or reduce the signs and symptoms of withdrawal, or overdose response training post discharge could save hundreds, if not thousands of lives each year with the cheap, and easy to use emergency interventions such as Naloxone to prevent overdoses from occurring should a discharged patient overdose.
The authors of the research say that discharge from hospital may be associated with an increased risk of death because a patient’s tolerance to drugs reduces over the days or weeks that they’re in hospital, leaving them vulnerable on discharge. Additionally, medicines such as methadone and buprenorphine that prevent drug withdrawal may not be available in hospital, or may not be available for the patient to continue using post discharge, meaning that the patient may not be able to begin a MAT treatment in hospital and continue with it upon discharge. which makes people more likely to use heroin as soon as they leave hospital. Finally, the illness, overdose or incident that caused someone to be admitted to hospital might make them more vulnerable to death after using opioids.
I was admitted to hospital because I accidentally overdosed on heroin when I took a hit from heroin I bought from a dealer whose drug I had not had before. It was stronger than I had estimated, and I ended up in a coma as a result. After being woken up 4 days after the event, I found myself in severe withdrawal. I asked hospital staff for help, however they couldn’t offer me methadone or other heroin replacement medications. I had some heroin delivered to the hospital which I injected in the toilet. However I ended up back in withdrawal once it began to wear off a short while later.
I then self-discharged the following day because I couldn’t cope with the severity of the symptoms I was experiencing. Had I been able to receive some support in hospital, I would have stayed and continued with my treatment that my Doctor said I urgently needed. Only time will tell what consequences this decision will have on my long-term prognosis.
T Johnson – 19 years old – Weymouth, Dorset, UK
Of the total number of 13,609 deaths, a further 236 deaths (1.7%) happened following drug use while admitted to hospital.
Co-author, Dr Thomas Brothers (UCL Institute of Epidemiology and Health Care & Dalhousie University / Nova Scotia Health, Canada), who specialises in treating addiction, said: “It’s possible these patients were admitted to a hospital ward and might have been found dead in a hospital toilet.
“We don’t want patients needing to treat their own withdrawal or pain and end up overdosing in the bathroom. Hospitals can do more to support these patients, by giving proper medication, safer spaces for drug use, or take-home naloxone kits which can reverse an opioid overdose. They’re easy to use, and between 75-100% effective.
Specific drug consumption facilities are another option which we need to consider if we’re to truly tackle the addiction epidemic in the UK. Let’s be honest, the method of punishing addicts with prison sentences, arrests and criminal records for possession hasn’t worked in the last decade, and it isn’t about to start working now. People will continue to use substances, whether they’re legal or not, so we must provide services that accept this fact and provide services that meet the honest needs of addicts who still use. We must adopt a medical/health oriented approach to addiction. After all, addiction is a recognised chronic medical condition! Even mobile versions exist, with positive research and data from pre-existing data from European DCR’s.
Lewer added: “We’re facing a public health crisis in the UK related to drug related deaths, and very sadly many of these deaths are completely avoidable. The research findings show that hospitals can, and should play a central role in stopping the escalating crisis in drug-related deaths. They can ensure that medicines such as methadone are available in the same way as they are in the community. They can also work with patients and their local community drug and alcohol service to plan discharge and make sure that these patients have somewhere safe to recover when they leave hospital.”
The research was funded by the National Institute for Health Research.
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