“Before Medically Advised” Discharge Linked to Risk for Overdose

MONDAY, Sept. 23, 2024 (HealthDay News) — “Before medically advised” (BMA) discharge from the hospital is associated with an increased risk for subsequent drug overdose, according to a study published online Sept. 23 in CMAJ, the journal of the Canadian Medical Association.

Mayesha Khan, from the University of British Columbia in Vancouver, Canada, and colleagues conducted a retrospective cohort study using administrative health data from a 20 percent random sample of residents of British Columbia, Canada, to examine whether BMA discharge increases the risk for subsequent drug overdose. A survival analysis was used to compare the rate of fatal and nonfatal illicit drug overdose in the first 30 days after BMA discharge versus after physician-advised discharge.

Overall, 3.4 percent of the 189,808 hospital stays ended in BMA discharge. The researchers found that 92 percent of the 820 overdoses occurring in the first 30 days after any hospital discharge involved patients with a history of substance use disorder. The unadjusted overdose rates were 10-fold higher after BMA versus physician-advised discharge; even after adjustment for potential confounders, BMA discharge was associated with subsequent overdose (crude incidence, 2.8 versus 0.3 percent; adjusted hazard ratio, 1.58). Increases in subsequent emergency department visits and unplanned hospital readmissions were seen in association with BMA (adjusted hazard ratio, 1.92 and 2.07, respectively); no significant association was seen with fatal overdoses and all-cause mortality.

“Hospitals and health systems should develop evidence-based protocols to prevent BMA discharge and should explore novel means of postdeparture outreach to reduce the risk of drug overdose after hospital discharge,” the authors write.

Abstract/Full Text