A new study finds that people with opioid addiction who received medical care through a general health care system, such as a primary care practitioner or a large research hospital, were more than 10 times as likely to die during a four-year period than those without substance abuse problems.
The study is the first to focus on the mortality rate of people with opioid use disorder in a general health care system rather than those being treated at specialty addiction clinics. The mortality rate among patients in a general health care setting was more than two times higher than what previous studies found in specialty clinics.
The findings suggest that health care systems need better infrastructure and training so that primary care physicians can diagnose and treat opioid use disorder, a condition that includes addiction to both prescription and illicit opioids.
“The high rates of death among patients with opioid use disorder in a general health care system reported in this study suggest we need strategies to improve detection and treatment of this disorder in primary care settings,” said Dr. Yih-Ing Hser, professor of psychiatry and behavioral sciences at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
Opioids are commonly prescribed to treat acute and chronic pain, and include prescription medications such as oxycodone (or OxyContin), hydrocodone (or Vicodin), codeine, morphine and fentanyl, as well as illicit substances such as heroin.
The number of opioid overdoses in the United States has quadrupled since 1999, leading many physicians and policymakers to declare the opioid problem a national crisis. The 21st Century Cures Act, legislation signed in December by former President Barack Obama, included one billion in funding to help states address opioid abuse.
As rates of opioid addiction have increased, people with opioid abuse problems increasingly are being treated by generalists in doctors’ offices. Until now, researchers had not measured the impact of this influx of patients with opioid abuse and addiction in primary care settings.
For the study, Hser and colleagues looked at the electronic health records, and an associated death index system, for 2,576 people, ages 18 to 64, diagnosed with opioid use disorder from 2006 to 2014.
These patients received health care at a major university hospital system. While all of those studied had diagnoses of opioid use disorder, not all were receiving treatment.
By the end of the study period, 18.1 percent of the study population (465 people) had died. Based on how long each individual had participated in the study — an average of about four years for each person — the researchers calculated a crude mortality rate of 48.6 deaths per 1,000 person-years. This is more than two times higher than the 20.9 deaths per 1,000 reported in earlier research conducted in specialty addiction clinics.
The rate was also more than 10 times higher than the expected death rate for people of the same age and sex in the general U.S. population.
“The findings were surprising because one would potentially expect better health care outcomes for patients being served by a large health care system,” Hser said. “Late identification of opioid use disorder and lack of addiction treatment could contribute to these high rates of serious health conditions and death.”
Overall, the patients in the new study were older at diagnosis and had a higher rate of other diseases and disorders compared to patients in previous studies from specialty clinics. The researchers found higher rates of both simultaneously occurring health complications — including hepatitis C, liver disease, cardiovascular disease, cancer, and diabetes — as well as other substance abuse disorders involving tobacco, alcohol, cannabis, and cocaine — among the patients who died.
Black or uninsured individuals were also more likely to die during the study period, the researchers said, a finding they noted highlights the need for additional research on disparities in addiction care.
More studies are needed, say the researchers, to determine how to best curb the mortality rates among all individuals with opioid use disorder and better integrate substance abuse disorder screening and treatment into primary care.
The findings are published in the Journal of Addiction Medicine.