Risk factors for opioid overdose among hospitalized patients

Area of Science:

• Medical research
• Clinical pharmacology
• Patient safety

Background:

• Hospitalized patients are susceptible to opioid overdose, yet risk factors remain poorly understood.
• Limited data exists on specific patient characteristics and conditions contributing to in-hospital opioid overdose events.

Purpose of the Study:

• To identify risk factors associated with opioid overdose among hospitalized patients.
• To inform the development of targeted interventions for preventing opioid overdose in clinical settings.

Main Methods:

• A case-control study identified opioid overdose cases via naloxone orders.
• Matched controls (no overdose) were selected, and data on patient demographics, opioid dosage, co-administered medications, renal function, and comorbidities were collected.
• Patients with a history of substance use disorder were excluded.

Main Results:

• Older age (≥65 years), intensive care unit (ICU) admission, and renal impairment (eGFR ≤60) were significantly associated with increased opioid overdose risk.
• Concomitant use of three or more central nervous system (CNS) depressants and a history of heart disease also correlated with higher overdose rates.
• Opioid overdose cases did not differ significantly in total daily opioid dose compared to controls.

Conclusions:

• Key risk factors for opioid overdose in hospitalized patients include advanced age, ICU stay, renal impairment, and concurrent CNS depressant use.
• These findings highlight the need for enhanced monitoring and preventative measures for at-risk patient populations.
• Identifying these risk factors can guide the implementation of targeted strategies to reduce opioid-related adverse events.