One-year mortality following emergency department visits for stimulant toxicity

Rising stimulant-related overdose deaths and emergency department (ED) utilization highlight the need to better characterize outcomes following ED encounters for stimulant toxicity. We sought to determine one-year mortality after ED discharge for stimulant toxicity and to characterize the causes of death.

This retrospective cohort study used a linked statewide database of ED and hospital discharge records and death records. Patients discharged from the ED with a primary diagnosis of stimulant toxicity, identified by International Classification of Diseases, Tenth Revision (ICD-10) codes, were included. The primary outcome was all-cause mortality within one year of ED discharge, estimated using Kaplan-Meier analysis. A secondary reference analysis was performed among patients with ED visits for acute opioid toxicity to contextualize mortality estimates against a population previously associated with elevated post-discharge mortality.

A total of 2356 patients met inclusion criteria. One-year mortality was 2.1% (95% confidence interval [CI] 1.6-2.8%). Among patients who died within one year, median age at the index visit was 35 years and median time to death was 118 days (interquartile range [IQR] 63-228 days). Overdose accounted for 67% of deaths, with opioids implicated in 54% and combined opioid-stimulant involvement in 37%. In the secondary reference cohort of 1665 opioid-related ED visits, one-year mortality was 6.9% (95% CI 5.8-8.3%).

Patients with ED encounters for stimulant toxicity experienced substantial one-year mortality in a relatively young population. Subsequent deaths were predominantly overdose-related and frequently opioid-involved, supporting consideration of opioid-focused harm-reduction interventions in this population.