Researchers from the School of Cancer & Pharmaceutical Science, led by Dr Caroline Copeland, in a collaboration with Dan Lewer from UCL wanted to understand whether people who use opiates are at increased risk of fatal overdose around the time of a hospital admission.
The study was prompted by a tragic case at a local hospital where a patient was found dead in the toilet at A&E after a heroin overdose. The researchers wanted to know if this was an isolated case or if hospitals are a high-risk environment for drug overdoses.
The team studied over 13,000 people who died due to an opiate overdose in England over ten years. They examined the history of hospital admissions for these individuals and found that fatal opiate overdoses are four times more likely in the two days after the hospital discharge. Overall, one in fourteen fatal opiate overdoses happen in the two weeks after hospital discharge.
They also found that people who leave hospital against their doctor's advice are at particularly high risk. Patients who use drugs such as heroin often report pain and withdrawal, because medicines for opiate addiction such as methadone may not be provided in hospital. This can lead patients to leave hospital early to use illegal drugs, while they are still unwell.
Drug related deaths are a public health crisis in the UK. We can cut the number of deaths by supporting people at the most difficult times. This study shows that hospital discharge is one of those critical moments.– Dan Lewer, lead researcher
In 236 cases, hospital patients died of an opiate overdose while admitted to hospital. These patients were admitted for other reasons, such as an infection, and then used drugs while in hospital and died.
The findings show that hospitals can play a central role in stopping the escalating crisis in drug-related deaths. They can ensure that medicines such as methadone are available in the same way as in the community. They can also work with patients and local drug and alcohol teams to plan discharge and make sure patients get home safely.
There needs to be better hospital polices and guidelines. Hospital staff are often unsure how to prescribe medicines like methadone, or how to treat pain when the patient uses opiates. However, there are evidence-based approaches in these areas, which can help patients stay in hospital, complete treatment, and go home safely. The researchers stress the need to avoid the situation where patients experience withdrawal and have to use drugs in the toilet.