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High Mortality Among Patients With Opioid Use Disorder in a Large Healthcare System

Hser, Yih-Ing, PhD; Mooney, Larissa J., MD; Saxon, Andrew J., MD; Miotto, Karen, MD; Bell, Douglas S., MD, PhD; Zhu, Yuhui, MS; Liang, Di, BM; Huang, David, DrPh

doi: 10.1097/ADM.0000000000000312
Original Research

Objectives: Elevated mortality has been observed among individuals with opioid use disorder (OUD) treated in addiction specialty clinics or programs. Information about OUD patients in general healthcare settings is needed in light of the current effort to integrate addiction services into primary healthcare systems. This study examined mortality rates, causes of death, and associated risk factors among patients with OUD in a large general healthcare system.

Methods: Mortality data were linked with electronic health records of 2576 OUD patients cared for in a large university health system from 2006 to 2014.

Results: There were 465 deaths confirmed (18.1% of the study participants), corresponding to a crude mortality rate of 48.6 per 1000 person-years and standardized mortality ratio of 10.3 (95% confidence interval [CI] 9.4–11.3). Drug overdose and disorder (19.8%), cardiovascular diseases (17.4%), cancer (16.8%), and infectious diseases (13.5%, including 12% hepatitis C virus [HCV]) were the leading causes of death. HCV (hazard ratio [HR] 1.99, 95% CI 1.62–2.46) and alcohol use disorder (HR 1.27, 95% CI 1.05–1.55) were 2 clinically important indicators of overall mortality risk. Tobacco use disorder (adjusted HR [AHR] 2.58, 95% CI 1.60–4.17) was associated with increased risk of cardiovascular death, HCV infection (AHR 2.55, 95% CI 1.52–4.26) with cancer mortality risk, and HCV (AHR 1.92, 95% CI 1.03–3.60) and alcohol use disorder (AHR 5.44, 95% CI 2.95–10.05) with liver-related mortality risk.

Conclusions: Patients with OUD in a general healthcare system demonstrated alarmingly high morbidity and mortality, which challenges healthcare systems to find innovative ways to identify and treat patients with substance use disorder.

University of California, Los Angeles, CA (Y-IH, LJM, KM, DSB, YZ, DL, DH); Veterans Affairs Puget Sound Health Care System, Seattle, WA (AJS).

Send correspondence to Yih-Ing Hser, PhD, UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025. E-mail:

Received 21 October, 2016

Accepted 8 February, 2017

Funding: This project has been funded in part with federal funds from the National Institute on Drug Abuse (NIDA), National Institutes of Health, Department of Health and Human Services, under contract HHSN271201400028C. Additional funding was provided by NIDA through grant P30DA016383, and by the National Center for Advancing Translational Science (NCATS) through grant number UL1TR001881 to the UCLA CTSI.

Conflicts of interest: Authors disclosing relevant financial interests, activities, relationships, and affiliations are as follows: AJS receives royalties as a section editor for UpToDate. All other authors report no financial or other possible conflicts of interest.

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© 2017 American Society of Addiction Medicine