A 10 Fold Increase Risk of Drug Overdose in Premature Discharge Cases: Study Finds

People who initiate a premature or "before medically advised" (BMA) hospital discharge have a 10-fold increase in the risk of drug overdose in the following month, according to new research in the Canadian Medical Association Journal.

Hospital patients who initiate a before medically advised discharge are up to 3 times more likely to die in the following year than people who undergo routine physician-advised discharge.

“For a long time, front-line doctors and nurses have wondered if before medically advised discharge increases subsequent overdose risk,” says Dr. John Staples, study senior author and a clinical associate professor at the University of British Columbia in Vancouver, BC. “For patients with substance use disorder, a long hospital stay can sometimes be a period of drug abstinence, potentially reducing opioid tolerance and interrupting access to [addiction] treatments. After these patients leave hospital, persistent pain and untreated addiction might prompt heavier-than-usual drug use. All these factors can increase the risk of subsequent overdose.”

To understand the link between before medically advised discharge and drug overdose, researchers conducted a study that examined health data on 189 808 hospital admissions occurring between 2015 and 2019 in British Columbia, Canada. A total of 6440 (3.4%) of these admissions ended with patients leaving hospital against medical advice. They found that patients with a before medically advised discharge were more likely to be younger males with psychiatric illness, substance use disorder, or a history of illicit drug use. The rate of fatal or nonfatal illicit drug overdose in the first 30 days after departure from hospital was 10 times higher after before medically advised discharge than after physician-advised discharge. “Before medically advised” discharge was associated with subsequent overdose even after accounting for other risk factors for overdose.

“These findings indicate that patients initiating a before medically advised discharge are at high risk of overdose, that before medically advised discharge may be a causal contributor to subsequent overdose, and that patients initiating a Before medically advised discharge, especially those with a history of substance use disorder, should be offered urgent clinical and social supports to reduce overdose-related harms,” write the authors.

Reference: Khan, M., Xiao, N., Crabtree, A., Moe, J., Nasmith, T., Daly-Grafstein, D., Brubacher, J. R., Slaunwhite, A. K., & Staples, J. A. (2024). Before medically advised departure from hospital and subsequent drug overdose: A population-based cohort study. CMAJ, 196(31), E1066-E1075. https://doi.org/10.1503/cmaj.240364