Staples John A, Hu Xiao, Khan Mayesha, Daly-Grafstein Daniel, Naik Hiten, Kaasa Benjamin M, Brubacher Jeffrey R, Nasmith Trudy, Lyden Jennifer R, Moe Jessica, Crabtree Alexis, Slaunwhite Amanda
Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada.
J Hosp Med. 2025 Feb;20(2):146-154. doi: 10.1002/jhm.13510. Epub 2024 Oct 1.
Patient-initiated or "before medically advised" (BMA) hospital discharge is more common among people who use drugs. Transitions of care can be destabilizing and might increase the risk of subsequent illicit drug overdose.
This study sought to evaluate whether BMA discharge is associated with an increased risk of subsequent drug overdose (primary objective) and whether physician-advised discharge is associated with an increased risk of subsequent drug overdose (secondary objective).
We performed a case-crossover analysis of population-based linked administrative health data for individuals experiencing an overdose between 2016 and 2019 in British Columbia, Canada. Using conditional logistic regression, we compared the likelihood of hospital discharge in the 28 days before overdose (the "pre-overdose interval") to the likelihood of hospital discharge in two self-matched 28-day control intervals ending 26 and 52 weeks before overdose.
Over the 3.5-year study interval, 235 of 27,584 (0.9%) pre-overdose intervals and 189 of 55,168 (0.3%) control intervals included a BMA discharge, suggesting that BMA discharge was associated with a twofold increase in the risk of subsequent drug overdose (adjusted odds ratio [aOR], 2.08; 95% confidence interval [95% CI], 1.68-2.58; p < 0.001). Physician-advised hospital discharge was also a risk factor for subsequent overdose, occurring in 1350 of 27,584 (4.9%) pre-overdose intervals and 1625 of 55,168 (2.9%) control intervals (aOR, 1.39; 95% CI, 1.27-1.52; p < 0.001).
Both BMA and physician-advised hospital discharge are independently associated with transient increases in the risk of subsequent illicit drug overdose. Better in-hospital treatment of substance use disorder and novel means of post-discharge outreach should be deployed to reduce this risk.
患者主动要求出院或“在医学建议之前”（BMA）出院在吸毒人群中更为常见。医疗护理的过渡可能会破坏稳定，并可能增加随后非法药物过量的风险。
本研究旨在评估BMA出院是否与随后药物过量风险增加相关（主要目标），以及医生建议出院是否与随后药物过量风险增加相关（次要目标）。
我们对2016年至2019年在加拿大不列颠哥伦比亚省发生过量用药的个体的基于人群的关联行政健康数据进行了病例交叉分析。使用条件逻辑回归，我们将过量用药前28天（“过量用药前间隔”）的出院可能性与两个自我匹配的28天对照间隔（分别在过量用药前26周和52周结束）的出院可能性进行了比较。
在3.5年的研究期间，27584个过量用药前间隔中的235个（0.9%）和55168个对照间隔中的189个（0.3%）包括BMA出院，这表明BMA出院与随后药物过量风险增加两倍相关（调整后的优势比[aOR]，2.08；95%置信区间[95%CI]，1.68 - 2.58；p < 0.001）。医生建议的出院也是随后过量用药的一个风险因素，在27584个过量用药前间隔中的1350个（4.9%）和55168个对照间隔中的1625个（2.9%）出现（aOR，1.39；95%CI，1.27 - 1.52；p < 0.001）。
BMA出院和医生建议的出院均与随后非法药物过量风险的短暂增加独立相关。应采用更好的住院期间物质使用障碍治疗方法和出院后新的外展方式来降低这种风险。
