Despite declining opioid-related ED discharges, heroin discharges boom
Although hospital discharges for prescription opioids have declined in recent years, discharges for heroin increased from 2008 and 2014, according to findings recently published in Health Affairs.
“The U.S. opioid epidemic has been termed the ‘worst drug crisis in American history,’” Dario Tedesco, PhD, postdoctoral scholar from the department of medicine, Stanford University, and colleagues wrote, adding that discussions about the opioid epidemic need to be a national priority.
Researchers used chi-square tests to compare differences in discharge distribution between inpatient and ED settings, accounting for region, sex and age group.
They utilized census data from 1997 to 2014, ICD-9-CM codes, Healthcare Cost and Utilization Project information for inpatient discharges from 1997 to 2014 and ED discharges from 2006 to 2014.
According to results, after 2008, ED discharge rates for heroin poisoning increased 31.4% each year. Conversely, from 2010 to 2014, discharge rates for prescription opioid poisonings decreased annually by 5.1% in the inpatient setting and 5% in the ED setting.
“This suggests that the expanded availability of lethal illicit drugs is being used to replace prescription opioids in some cases,” Tina Hernandez-Boussard, PhD, associate professor of medicine of biomedical data sciences and surgery at Stanford University, said in a press release, adding that the decrease in hospital discharges due to prescribed opioids could be an indication that initiatives to curtail their over-prescription are beginning to work.
Additional findings related to inpatient discharges for opioid poisoning, abuse or dependence included:
•Patients aged 18 to 44 years accounted for 73.88% of discharges in 1997 and 50.06% of discharges in 2014.
•Patients older than 65 years accounted for 3.13% of discharges in 1997 to 9.92% of discharges in 2014.
•Female patients accounted for 42.06% of discharges in 1997 and 49% of discharges in 2014.
•Patients in the South and West accounted for 43.44% of discharges in 1997 and 53.17% of discharges in 2014.
•Patients in the Midwest and Northeast accounted for 56.56% of discharges in 1997 and 46.83% of discharges in 2014.
In an interview with Healio Family Medicine, Hernandez-Boussard commented on data from some of the years not covered by the analysis.
“We did not develop any models to predict future trends. However, as more restrictions are being placed on opioid prescriptions, it is likely these trends continued beyond 2014,” she said. “Furthermore, the sharp increase we found in heroin-related discharges are concurrent with the recent report from the CDC that showed significant increases in fentanyl deaths through 2016. This suggests that the trends we described will continue.”
Hernandez-Boussard said that health care and legal systems need to be appropriately trained and staffed to recognize and treat opioid-related admissions and patients with opioid dependence.
“Furthermore, these systems need to ensure that safety strategies are in place, such as overdose response programs,” she said, later adding that primary care physicians can stress to patients that a goal is to promote suitable, and perhaps limited, opioid prescribing for optimal pain management to maximize benefits and minimize harms.
“Patients and the general public need to be informed that new illicit fentanyl derivatives may be sold as heroin, but they may be thousands of times more potent, leading to higher risk of adverse events,” Hernandez-Boussard said. – by Janel Miller
Disclosure: Tedesco reports no relevant financial disclosures. Healio Family Medicine was unable to confirm the other authors’ relevant financial disclosures at the time publication.