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How can we prevent overdose after early departure from hospital?

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People who use drugs are more likely than non-drug users to leave hospital before it is medically recommended, which is associated with a tripling of short-term mortality. A new study led by CHÉOS Scientist Dr. John Staples seeks to determine whether these deaths are the result of overdose and, if so, how they can be prevented.

Dr. John Staples

“People depart hospital against medical advice for a range of reasons including inadequate treatment of pain, insufficient management of opioid withdrawal, stigmatization of substance use disorder, and challenges coping with the psychological stress of illness,” explained Dr. Staples, an Internal Medicine physician based at Vancouver General Hospital and a Clinical Assistant Professor at UBC. These factors, along with others, can also increase the risk of subsequent overdose.

“We have existing evidence-based programs that help reduce overdose risk, like take-home naloxone kits and low-barrier follow-up addictions care,” said Dr. Staples. “This project will inform how these treatments are deployed after unplanned hospital departure.”

The study will leverage the Provincial Overdose Cohort, an administrative health database that includes the anonymized data of the thousands of individuals who have had a fatal or non-fatal illicit or prescription drug overdose in BC between 2015 and 2019. Dr. Staples’ research team will analyze these data to determine the factors that affect the risk of overdose after leaving hospital, specifically examining the role of early initiation of methadone and Suboxone. The researchers will also look at the factors that contribute to hospital readmission, which can be a major burden on patients and the health care system.

The study results will be used to design and implement specific interventions to help prevent overdose in people who leave hospital against medical advice.

“The clinician–scientists on our study team are embedded in Vancouver’s health system and are positioned to adapt current protocols and programs in response to our findings,” explained Dr. Staples.

“Deaths from drug overdoses in Vancouver have increased eight-fold in the past decade, but the risk of overdose after unplanned hospital departure remains unstudied,” said Dr. Staples. “We hope to shed some light on this problem in order to prevent overdoses and save lives.”

This project is funded through the VCHRI Innovation and Translation Awards, and includes researchers from UBC, Vancouver General Hospital, and St. Paul’s Hospital.