In-hospital opioid overdose deaths among intensive care patients in the United States have increased by a rate of 0.5% each month since 2009, and ICUs across the country are feeling the strain of dealing with a rising number of heroin and prescription opioid overdose patients, researchers reported here.
A review of billing codes data involving 4.9 million ICU admissions at more than 200 hospitals in 44 states showed a 46% increase in ICU admissions for opioid overdoses during the 6-year period between 2009 and 2015, and an 86% increase in opioid deaths.
The finding points to a need for more coordinated and uniform nationally recognized strategies for treating heroin and prescription overdoses in the ICU, critical care physician Jennifer P. Stevens, MD, of Beth Israel Deaconess Medical Center, Boston, said Monday.
Stevens is scheduled to present the study findings at ATS 2016, the international meeting of the American Thoracic Society.
“What this means is that the opioid-use epidemic has probably reached a new level of crisis, and that despite everything we do in the ICU to keep patients alive, including ventilation, acute dialysis, life support and around-the-clock care, we are not seeing an improvement in mortality,” Stevens said.
Stevens and colleagues analyzed data from hospitals across the country affiliated with Vizient (formerly the University Health System Consortium), and their final cohort included 17.6 million hospital adult admissions.
Both opioid overdose-related hospital admissions and ICU admissions increased, with ICU admissions for opioid overdoses increasing from 45 patients per 10,000 ICU admissions in 2009 to 65 patient per 10,000 ICU admissions in 2015.
The rate of acute dialysis in opioid overdose patients also increased in ICUs, while the rate of mechanical ventilation seems to have remained steady, Stevens said.
The observational data do not explain why mortality among patients who enter ICUs with opioid overdoses is rising, and data on the use of opioid-reversing drugs by first responders prior to hospital arrival or by emergency department personnel were not available.
Pulmonary and critical care specialist Dean Schaufnagel, MD, of the University of Illinois at Chicago, who was not involved with the study, said patients who are admitted to or dying in ICUs from opioid overdoses are most likely those who have been found late and may have been comatose for a while.
“They are resuscitated, but there may be brain damage or other very serious issues ,” he said.
Schaufnagel, who is a past president of ATS, said changing clinicians’ views about how they manage their patients’ pain is critical to addressing the prescription opioid overdose epidemic in the U.S.
“The thinking a decade or so ago was that doctors had no right to allow patients to be in pain,” he said. “When I had a wisdom tooth taken out a few years ago they gave me a big bottle of Tylenol with codeine and there was a refill. That was part of this mindset of making sure patients had no pain. This was well meaning, but that thinking backfired.”