Level of care following suspected opioid or stimulant overdose with self-harm intent

Overdose-related hospital utilization is influenced by both pharmacologic effects and psychosocial context. This multicenter subanalysis from the Drug Overdose Toxico-Surveillance (DOTS) Reporting Program assessed differences in care based on the intentionality of opioid and stimulant overdoses.

Data from 17 U.S. emergency departments (April 2023-September 2024) included 777 patients with confirmed opioid or stimulant overdoses, categorized as intentional (e.g., self-harm) or unintentional (e.g., recreational use, therapeutic error). Primary outcomes were hospital admission and length of stay; secondary outcomes included ICU utilization, gender distribution, and substances involved. Statistical analysis included chi-square and t-tests.

Of 777 patients, 51 (6.6 %) were classified as intentional overdoses. Hospital admission was more common in intentional cases (67 %) than unintentional (56 %; p = 0.02). Unintentional overdoses were more often discharged directly from the emergency department (52 % vs. 37 %; p = 0.031). Intentional overdoses more frequently resulted in hospital stays exceeding four days, whereas most unintentional cases were discharged within one day. ICU admission rates did not differ significantly. The intentional group had a balanced gender distribution, while males represented 74 % of unintentional cases. Opioids were the most common substances, though intentional cases had more undifferentiated exposures.

Intentionality significantly influenced admission rates and hospital length of stay, likely reflecting psychosocial rather than physiological factors. These findings highlight the need for standardized disposition strategies that consider both medical and psychiatric needs. Future research should focus on tools to guide evidence-based, equitable resource use in overdose care.