Aug 11 2017
The opioid crisis in the United States is resulting in increased admissions to hospital intensive care units and in increased numbers of ICU deaths from opioid overdoses, according to new research published online, ahead of print in the Annals of the American Thoracic Society.
In "The Critical Care Crisis of Opioid Overdoses in the United States," researchers report that between Jan. 2009 and Sept. 2015, admission to the ICU at 162 U.S. hospitals in 44 states increased by 34 percent. During that same time, deaths from these overdoses averaged 7 percent but rose to 10 percent by 2015. These statistics taken together, the researchers estimate, indicate that deaths in these ICUs from opioid overdoses nearly doubled over the seven years. The researchers also found that the cost of caring for these patients increased from $58,517 to $92,408 (in 2015 dollars) in the same period. "The opioid epidemic has reached a new level of crisis," said lead study author Jennifer P. Stevens, MD, associate director of the medical intensive care unit at Beth Israel Deaconess Medical Center and assistant professor at Harvard Medical School. "This study tells us that the opioid epidemic has made people sicker and killed more people, in spite of all the care we can provide in the ICU, including mechanical ventilation, acute dialysis, life support and round-the-clock care."
The authors believe that their report provides the first description of the impact of the opioid addiction crisis on the nation's ICUs. Their data source was the Clinical Data Base/Resource ManagerTM. Over seven years, 4,145,068 patients required ICU care at the hospitals contributing to the data base. Of those, 21,705 were patients who had overdosed on opioids, most commonly heroin.
Among the opioid overdose patients, 25 percent experienced aspiration pneumonia, 15 percent rhabdomyolosis (release of dead muscle fiber into the bloodstream), 8 percent anoxic brain injury and 6 percent septic shock. Ten percent of patients who overdosed needed mechanical ventilation.
The study could not determine whether increased ICU admissions for opioid overdoses resulted from improved community emergency response that saved lives but then required critical care or whether the increased ICU admissions indicated the community emergency response needed to be improved so that patients could recover with lower levels of hospital care.
"These data don't tell us whether the problem is with the drugs themselves, challenges with pre-hospital care for patients with overdose, our care in the ICUs or some combination of these factors," Dr. Stevens said. "The urgency of our findings, however, suggests the need for a larger, national approach to developing safe strategies to care for patients with overdose in the ICU, to provide coordinated resources in the hospital for patients and families and to help survivors maintain sobriety on discharge."
The authors also argue in their article that "any admission to the ICU for opioid overdose is a preventable admission."
Study limitations include the fact that nearly all hospitals participating in the Clinical Data Base/Resource ManagerTM are located in cities, and most are part of academic medical centers. Findings may not be generalizable to communities with fewer critical care resources.