Health Care Utilization and Premature Mortality Following the Survival of a Nonfatal Opioid Overdose Among Nonelderly Individuals Dually Enrolled in Medicare and Medicaid, 2016

Background and Purpose:

Over 400,000 people in the United States have died from opioid overdoses in the last 20 years. This crisis has disproportionately impacted disabled Medicare and Medicaid beneficiaries, who experience opioid overdose mortality rates more than 4 times higher than the general US population. Knowledge about when and where these vulnerable individuals access health care following an overdose, and their health outcomes, may provide key information about the best allocation of public health resources and possible points of intervention for substance use treatment. This study asks: 1) What factors are associated with mortality in the 12 months following a nonfatal opioid overdose among individuals under the age of 65 dually enrolled in Medicare and Medicaid (nonelderly duals), and 2) What are the health care utilization behaviors of nonelderly duals following a nonfatal opioid overdose?

Methods:

This study uses 2016 nation-wide Medicare fee-for-service claims data for nonelderly duals who experienced a nonfatal overdose. Nonelderly duals who were eligible for Medicare based on end-stage renal disease and those with cancer diagnoses are excluded. A qualifying criterion into this study is at least one primary or secondary diagnosis for substance overdose at the time of visit or admission to the emergency department. The beneficiaries’ comorbidities, subsequent health care utilization, and 12-month mortality outcomes were assessed. Logistic regression was used to assess factors associated with 12-month mortality. Health care utilization included both inpatient and outpatient services.

Results:

Over 10% of the 14,193 nonelderly duals who experienced a nonfatal opioid overdose in 2016 died within 12 months of the event. A significant proportion of those who died had diagnoses of dangerous comorbidities that were associated with subsequent mortality, including chronic kidney disease (61%; OR=1.8, p<0.0001), chronic obstructive pulmonary disease (51%; OR=1.2, p<0.0001), and heart failure (40%; OR=1.6, p<0.0001). Individuals who overdosed, regardless of mortality outcome, had numerous health encounters in the 12 months following the overdose. Those who overdosed and died within 12 months had 23 visits on average prior to death.

Conclusions and Implications:

Nonelderly duals face multiple and intersectional barriers to their well-being: poverty, disability, medical comorbidity, and the complexity of overlapping public coverage. Visits to health care facilities following a nonfatal overdose may provide critical points for intervention. The findings from this study have the potential to help clinical social workers and health care providers identify those most in need of substance use treatment, as well as times and places at which treatment may be most impactful. This study is also pertinent to policymakers, who seek to identify opportunities for interventions to assist this vulnerable population. Future analyses in this study will address 1) the effects of competing risks of conditions related to disability on 12-month mortality from substance overdose among nonelderly duals, and 2) the association between the timing, frequency, and/or site of care with 12-month survival following a nonfatal opioid overdose among nonelderly duals.