High mortality among patients with opioid use disorder in a large healthcare system.
This is the Results Article for CTN-0066-Ot.
Elevated mortality has been observed among individuals with opioid use disorder (OUD) treated in addiction specialty clinics or programs. Information about OUD patients in general healthcare settings is needed in light of the current effort to integrate addiction services into primary healthcare systems. This study examined mortality rates, causes of death, and associated risk factors among patients with OUD in a large general healthcare system. Mortality data were linked with the electronic health records of 1,683 OUD patients cared for in a large university health system from 2006-2014 (UCLA of the former CTN Pacific Region Node).
There were 465 deaths confirmed (27.6% of the study participants), corresponding to a crude mortality rate of 68.7 per 1000 person-years and SMR of 15.9 (95% CI, 14.5-17.4). Drug overdose and disorder (19.4%), cardiovascular diseases (16.9%), cancer (16.3%), and infectious diseases (14.5%, including 12% hepatitis C virus [HCV]) were the leading causes of death. HCV (HR: 2.08, 95% CI, 1.68-2.59) and cannabis use disorder (HR: 1.63, 95% CI, 1.28-2.07) were two clinically important indicators of overall mortality risk. Chronic pain (AHR: 1.92, 95% CI, 1.16-3.19) and tobacco use disorder (AHR: 2.88; 95% CI, 1.80-4.63) were associated with increased risk of cardiovascular death, HCV infection with cancer mortality risk (AHR: 2.51, 95% CI, 1.47-4.28), and alcohol use disorder with liver-related mortality risk (AHR: 5.06, 95% CI, 2.72-9.42).
Conclusions: Patients with OUD in a general healthcare system demonstrated alarmingly high morbidity and mortality, which challenges health care systems to find innovative ways to identify and treat patients with substance use disorder. Given the chronic, relapsing nature of OUD, and high medical and psychiatric comorbidity, continued care encompassing screening, early intervention, support, and monitoring is essential.
Related protocols: CTN-0066-Ot