Opioid overdoses leading to more ICU admissions and deaths

(Reuters Health) - A growing number of Americans are needing intensive care for opioid overdoses and dying after receiving treatment for serious complications, a U.S. study suggests.

Captain Richard Flynn demonstrates the Overdose Detection Mapping Application Program (ODMAP) which maps various types of opioid overdose responses entered into an app by first responders and which is being adopted by the police department in Arlington, Massachusetts, U.S., July 19, 2017. REUTERS/Brian Snyder

Opioid-related overdose deaths have doubled since 2000 amid a worsening epidemic of addiction to both prescription painkillers like oxycodone and illegal drugs like heroin, researchers note in the American Journal of Respiratory and Critical Care Medicine.

Alongside this worsening trend, opioid overdose admissions requiring treatment in hospital intensive care units (ICUs) surged 34 percent from 2009 to 2015, the study found. During this same period, the death rate for these ICU patients climbed from 7.3 percent to 9.8 percent.

“There are growing numbers of people who are so sick from their opioid overdose that they need ICU-level care, and despite everything we can do in the ICU more patients are dying in the ICU with complications from their overdose than ever before,” said lead study author Dr. Jennifer Stevens of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.

“So when we think of overdoses, we need not to just think about whether people died or survived, but also about the tremendous personal and societal costs of the serious medical problems that can come from overdoses for people who didn’t die, or didn’t die immediately,” Stevens said by email.

She and her colleagues examined data on more than 4.1 million patients admitted to ICUs in 162 hospitals in 44 states, including 21,705 with opioid overdoses, usually from heroin.

During the seven-year study period, the cost of caring for ICU patients who had opioid overdoses increased from $58,517 to $92,408 in 2015 dollars.

Among the opioid overdose patients, 25 percent experienced aspiration pneumonia, bacterial infections that happen when food, saliva or vomit is breathed into the lungs instead of remaining in the digestive tract.

The second most common complication was rhabdomyolysis, or the release of dead muscle fiber into the bloodstream, which occurred with 15 percent of the overdose patients in the ICU.

Eight percent of the patients had brain injuries and 6 percent had septic shock, a life-threatening response to infections that can cause serious organ damage.

One in ten people treated in the ICU after overdoses needed mechanical ventilation machines to help them breathe.

The study wasn’t designed to explain why more overdoses are being treated in ICUs. It’s possible that heightened awareness about overdoses is helping more people survive long enough to be admitted to the hospital. It’s also possible that people are having worse overdoses today than they did in the past, the researchers note.

Most likely, both possibilities are behind the surge in overdose patients in the ICU, said Dr. Marc LaRochelle, a researcher at Boston Medical Center’s Grayken Center for Addiction Medicine who wasn’t involved in the study.

“It likely reflects some contributions from at least two factors: one is increasing potency of opioid supply with a spike in illicit fentanyl in recent years,” LaRochelle said by email, referring to a fast-acting, highly potent prescription opioid that’s become a common recreational drug.

“A second would be more widespread overdose education and naloxone distribution programs,” LaRochelle added. Naloxone can block the effect of opioids and rapidly reverse the effects of an overdose.

“People who use injection drugs should obtain naloxone, the overdose reversal drug, and use drugs with partners who can help them,” said Brendan Saloner, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn’t involved in the study.

In many states, family members can get naloxone, sometimes without a prescription, Saloner said by email. Two medications, buprenorphine and methadone, can also help reduce drug use.

“There is unfortunately a lot of stigma about medication treatments, but they are safe and work,” Saloner added. “Long-term change is possible and recovery is a realistic goal, but it requires time and patience.”

SOURCE: American Journal of Respiratory and Critical Care Medicine, online August 11, 2017.