Opioid Crisis Impacts ICU Admissions and Mortality

The opioid crisis in the United States is resulting in increased admissions to hospital intensive care units (ICUs) and in increased deaths from opioid overdose, according to a new study.

Researchers at Beth Israel Deaconess Medical Center (BIDMC; Boston, MA, USA) and the University of Chicago (IL, USA) conducted a retrospective cohort study of all adult admissions from 162 hospitals in 44 states discharged between January 1, 2009, and September 31, 2015, in order to determine the incidence of ICU admissions for opioid overdose. Admissions were identified using the Vizient Clinical Data Base/Resource Manager (CDB/RM).

The final study cohort included 22,783,628 ICU admissions, of which 4,145,068 patients required treatment for opioid overdose; this translates into an average of 52.4 ICU overdose admissions per 10,000 ICU admissions. Over the course of the study period, ICU admissions increased by 34%, while deaths from overdose, which averaged 7% in 2009, rose to 10% by late 2015. Taken together, the data indicate that the number of nominal ICU deaths from opioid overdose nearly doubled over the seven-year period.

Of these patients, 21,705 overdosed on opioids, most commonly heroin. Clinically, 25% experienced aspiration pneumonia, 15% rhabdomyolosis (release of dead muscle fiber into the bloodstream), 8% experiences anoxic brain injury, 10% needed mechanical ventilation, and 6% underwent septic shock. The study could not determine whether increased ICU admissions resulted from improved community emergency response, or if they indicated the community emergency response needed to be improved, so that patients could recover with lower levels of hospital care. The study was published on August 11, 2017, in Annals of the American Thoracic Society.

“This study tells us that the opioid epidemic has made people sicker and killed more people, in spite of all the care we can provide in the ICU, including mechanical ventilation, acute dialysis, life support, and round-the-clock care,” said lead author Jennifer Stevens, MD, associate director of the medical ICU at BIDMC, who added that “these data don't tell us whether the problem is with the drugs themselves, challenges with pre-hospital care for patients with overdose, our care in the ICUs, or some combination of these factors.”

Prescriptions of opioid medications for chronic pain in the United States have increased dramatically, a trend that has been accompanied by greatly increased levels of prescription opioid overdose, abuse, addiction, and diversion.

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Beth Israel Deaconess Medical Center
University of Chicago