Drug users just getting out of the hospital have another rough patch in store, according to a new UK report showing elevated death rates among freshly discharged patients.
Rates of suicides and overdose deaths were more than 10 times higher for drug users who had been out of the hospital for less than a month than for those who had been out for at least a year, researchers found.
"Like prison-release, hospital discharge marks the start of a well-defined period of heightened vulnerability for drug-treatment clients," Elizabeth Merrall of the MRC Biostatistics Unit in Cambridge and colleagues write in their report.
Their study, published in the journal Addiction, is based on records from nearly 70,000 people in Scotland who had been treated for some type of substance abuse.
By linking national registers with treatment registrations, the researchers found that overdose deaths and suicides were most common during hospital stays - likely because many patients were admitted for these very problems and resuscitation was unsuccessful.
But even after discharge the rates remained high. In the first 28 days, there were 21 drug-related deaths per 1,000 people per year, compared to 4.2 per 1,000 people a year or more later. The overdose rate was even lower among users who had never been hospitalized.
Suicides unrelated to drug use dropped from 3.9 per 1,000 people per year in the first month to less than one per 1,000 people per year after a year.
It's possible that drug users, particularly those dependent on heroin or prescription opioids, start binging after they get out of the hospital or lose some of their drug tolerance at the hospital, making it easier to overdose, said Dr. Patrick G. O'Connor.
"You do start to lose some tolerance right away," explained O'Connor, an addiction expert at Yale School of Medicine in New Haven, Connecticut, who was not involved in the research. "I think the loss of tolerance is a contributor, but there are probably other factors as well."
It could be, as suggested by the UK researchers, that "hospital contact may simply represent a desperate, sometimes final, call for help."
But a few days at the hospital are not going to fix a life that is threatening to collapse, O'Connor said, adding that many substance abusers may need housing, jobs and psychiatric help.
"For drug users who leave the hospital, we need to be able to provide instantaneous and tight linkages for these patients to at least three services: primary care services, social services and drug treatment services," he told Reuters Health.
While Scotland has a national overdose prevention program and universal healthcare, many people in the U.S. don't even have basic health insurance, "so the approach is even more important in our environment," O'Connor added.
REFERRALS UPON DISCHARGE?
It's estimated that some 3.7 million Americans have used heroin at some point in their lives and in 2008 alone, opioid pain relievers such as Vicodin were involved in 14,800 deaths.
The drug naloxone works as an antidote to heroin and other opioids and is available freely from more than 180 overdose prevention programs across the U.S., according to Eliza Wheeler of the Harm Reduction Coalition, a national drug user advocacy group.
But most hospitals are unlikely to refer drug users to such programs upon discharge, she told Reuters Health. A national overdose program locator can be found here.
"There has been some effort to implement those programs in a more clinical setting," Wheeler said, "but it has been a slow process."
The study is published in journal Addiction.