Service Use Preceding Opioid-Related Fatality

Area of Science:

• Health Services Research
• Public Health
• Pain Management

Background:

• Opioid-related deaths remain a significant public health crisis.
• Understanding health service patterns preceding death is crucial for intervention.
• Nonelderly Medicaid beneficiaries represent a vulnerable population with high opioid use.

Purpose of the Study:

• To analyze health service utilization before opioid-related death.
• To compare patterns between decedents with and without chronic noncancer pain diagnoses.
• To identify clinical diagnoses and medication use in the year prior to death.

Main Methods:

• Retrospective cohort study of Medicaid beneficiaries aged ≤64 years with opioid-related deaths.
• Characterization of clinical diagnoses, filled prescriptions, and nonfatal poisonings within 30 days and 12 months before death.
• Stratification of 13,089 decedents based on chronic noncancer pain diagnoses in the last year of life.

Main Results:

• 61.5% of decedents had chronic noncancer pain diagnoses in the last year of life.
• Chronic pain patients were more likely to receive opioid (49.0% vs 17.2%) and benzodiazepine (52.1% vs 26.6%) prescriptions in the last 30 days.
• Diagnoses of drug use (40.8% vs 22.1%), depression (29.6% vs 13.0%), and anxiety (25.8% vs 8.4%) were more common in the chronic pain group.

Conclusions:

• Opioid-related decedents, especially those with chronic pain, frequently received care for substance use and mental health disorders.
• Opioid use disorder diagnoses were infrequent near the time of death in both groups.
• Health service patterns highlight the complex comorbidities associated with opioid-related mortality.