The Critical Care Crisis of Opioid Overdoses in the United States

• Published in: Annals of the American Thoracic Society Vol. 14; no. 12; pp. 1803 - 1809
• Main Authors: Stevens, Jennifer P, Wall, Michael J, Novack, Lena, Marshall, John, Hsu, Douglas J, Howell, Michael D
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.12.2017
• Subjects: Adolescent; Adult; Age Distribution; Aged; Analgesics, Opioid - poisoning; Codes; Consortia; Critical care; Critical Care - trends; Demographics; Disease control; Drug overdose; Drug Overdose - mortality; Epidemics; Epidemiology; Female; Heroin; Hospitals; Humans; Intensive care; Intensive Care Units - statistics & numerical data; Intensive Care Units - trends; Male; Middle Aged; Mortality; Narcotics; Original Research; Patient Admission - statistics & numerical data; Patient Admission - trends; Prescription drugs; Prevention; Regression Analysis; Retrospective Studies; Rural areas; Sex Distribution; Studies; Trends; United States - epidemiology; Ventilators; Young Adult; opioid overdoses; critical care; epidemiology
• ISSN: 2329-6933; 2325-6621
• DOI: 10.1513/annalsats.201701-022oc

Opioid abuse is increasing, but its impact on critical care resources in the United States is unknown. We hypothesized that there would be a rising need for critical care among opioid-associated overdoses in the United States. We analyzed all adult admissions, using a retrospective cohort study from 162 hospitals in 44 states, discharged between January 1, 2009, and September 31, 2015 to describe the incidence of intensive care unit (ICU) admissions for opioid overdose during this time. Admissions were identified using the Clinical Database/Resource Manager of Vizient, the successor to the University Health System Consortium. Our primary outcome was opioid-associated overdose admissions to the ICU. The outcome was defined on the basis of previously validated ICD-9 codes. Our secondary outcomes were in-hospital death and markers of ICU resources. The final cohort included 22,783,628 admissions; 4,145,068 required ICU care. There were 52.4 ICU admissions for overdose per 10,000 ICU admissions over the entire study (95% confidence interval [CI], 51.8-53.0 per 10,000 ICU admissions). During this time period, opioid overdose admissions requiring intensive care increased 34%, from 44 per 10,000 (95% CI, 43-46 per 10,000) to 59 per 10,000 ICU admissions (95% CI, 57-61 per 10,000; P < 0.0001). The mortality rate of patients with ICU admissions with overdoses averaged 7% (95% CI, 7.0-7.6%) but increased to 10% in 2015 (95% CI, 8.8-10.8%). The number of deaths of ICU patients with opioid overdoses increased substantially in the 7 years of our study, reflecting increases in both the incidence and mortality of this condition. Our findings raise the need for a national approach to developing safe strategies to care for patients with overdose in the ICU, to providing coordinated resources in the hospital for patients and families, and to helping survivors maintain sobriety on discharge.