Recent health care reforms promote the expansion of substance use disorder treatment into primary care settings. The goals are to reduce morbidity and mortality by facilitating earlier recognition of patients’ substance use problems, coordinated treatment of substance use disorders and comorbid conditions, and improved models for treating the chronic relapsing nature of substance use disorders.
Reducing mortality related to opioid use disorders is among the most urgent objectives of the reforms. A new report provides information that primary care physicians and health care systems can use as they develop responses to the reforms and measure their success. The findings provide a baseline estimate of the excess mortality suffered by patients with opioid use disorder who are treated in a general health care system, and identify the main proximate causes of this mortality.
Investigators from the University of California and Veterans Affairs Puget Sound Health Care System linked the Centers for Disease Control and Prevention’s National Death Index data with electronic health care records of 2,576 opioid use disorder patients treated in a large university health care system from 2006 to 2014. The mortality rate among these patients was more than 10 times higher than that among the general population, after adjusting for age and sex (standardized mortality ratio 10.3). The most common causes of death were drug related (19.8 percent), cardiovascular disease (17.4 percent), cancer (16.8 percent), infectious disease (13.5 percent), and disease of the digestive system (12.2 percent).
The researchers noted that the mortality rates among the patients in their study exceed those previously reported for patients treated in specialized substance use disorder treatment programs. They propose that educating and engaging primary care physicians to more readily identify, refer, and follow patients with opioid use disorders can narrow this difference and reduce opioid-related mortality overall.
- Hser, Y.I. et al. High mortality among patients with opioid use disorder in a large healthcare system. Journal of Addiction Medicine. http://journals.lww.com/journaladdictionmedicine/Abstract/publishahead/High_Mortality_Among_Patients_With_Opioid_Use.99558.aspx