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Mortality Risk After Naloxone

March 31, 2020

Written by Aaron Lacy

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Patients who have out-of-hospital opioid overdose reversal with naloxone have a 13-fold increase in one-year mortality compared to the general population.

Why does this matter?
We know that naloxone use in out-of-hospital opioid overdoses saves lives. Intuitively, we know that these patients are at a higher risk of future mortality, but how much higher is that risk? Knowing that information could change the way we disposition these patients after the acute overdose is over and they are ready for discharge.

Sobering Statistics
This was a regional retrospective cohort study looking at the administration of out-of-hospital naloxone administration in 7 North Carolina counties.  Over the span of roughly 2 years, 3,085 patients received naloxone, with 72.7% having clinical improvement. Mortality at day 0, 1, 30, and 365 was 0% (0-0.3 95% CI), 0.6% (0.3-1.0 95% CI), 3.6% (2.8-4.4 95% CI) and 12% (95% CI), respectively. Patients in this group were 13.2 (13.0-13.3 95% CI) times more likely to be dead at 1 year when compared to the general population. Percent mortality was higher at all timeframes in those who did not have clinical improvement with naloxone. This is likely due to the fact that they were given naloxone for respiratory depression or altered mental status that was not secondary to opioids, which could mean pathology linked to a worse prognosis, such as stroke. Interestingly, those who required multiple doses of naloxone did not have increased likelihood of death at 1 year. Older age and black race were associated with 1-year mortality. A 3.6% mortality rate in this population at 30 days warrants attention. We may need to be more aggressive with our discussions and resources for help in this patient population before they go out the door.

One-Year Mortality and Associated Factors in Patients Receiving Out-of-Hospital Naloxone for Presumed Opioid Overdose. Ann Emerg Med. 2020 Jan 23. pii: S0196-0644(19)31422-2. doi: 10.1016/j.annemergmed.2019.11.022. [Epub ahead of print]

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