Age and intensive care unit admissions following opioid overdose

Older adults are increasingly impacted by the opioid crisis, yet age-related differences in overdose presentation, management, and outcomes leading to intensive care unit (ICU) admission remain poorly characterized. This study examined age-related variations in drug exposures, interventions provided, and hospital utilization among patients experiencing an opioid overdose.

The Toxicology Investigators Consortium (ToxIC) Fentalog Study was conducted at 10 US medical centers and collected data on patients who presented to emergency departments with confirmed non-fatal opioid overdose, and available waste serum samples between 9/21/2020-4/14/2026 were included. Chart reviews captured presentations, treatments, and hospital utilization. Toxicologic analyses were performed at the Center for Forensic Science Research and Education. Nested multivariable logistic regressions assessed whether age improved predicted ICU admission, after accounting for sociodemographic characteristics and drug classes detected.

Among 1930 patients, 15.3% were admitted to the ICU, 7.8% received cardiopulmonary resuscitation, and 5.8% were intubated. Length of hospital stay varied by age, with patients 65 + years old staying longest (median: 22.0h, IQR: 87.0, p < 0.001). Illicit opioids were less commonly detected in older adults (p < 0.001), while prescription opioids were more common (p < 0.001). Age cohort did not significantly predict ICU admission, although prescription benzodiazepine (AOR: 1.4, 95% CI: 1.1, 1.9) and opioid (AOR: 0.7, 95% CI: 0.5, 0.9) detection did.

Older age was associated with longer hospital stays but did not predict ICU admission after adjustment for relevant covariates. Benzodiazepine and opioid exposures showed a modest association with ICU utilization. Further work should clarify how pharmacologic combinations influence clinical severity across age groups.