Opioid overdoses leading to more ICU admissions and deaths

(Reuters Health) - A growing number of Americans are needing intensive care for opioid overdoses and dying after receiving treatment for serious complications, a U.S. study suggests.

Opioid-related overdose deaths have doubled since 2000 amid a worsening epidemic of addiction to both prescription painkillers like oxycodone and illegal drugs like heroin, researchers note in the American Journal of Respiratory and Critical Care Medicine.

28 PHOTOS
Opioid and drug crisis in America
See Gallery
Opioid and drug crisis in America
Discarded needles are seen at a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 7, 2017. In North Philadelphia, railroad gulch as it is knowen, is ground zero in Philadelphia?s opioid epidemic. Known by locals as El Campanento, the open air drug market and heroin encampment is built with the discarded materials from the gulch and populated by addicts seeking a hit of heroin to keep their dope sick, or withdrawal symptoms, at bay. In one area, near the 2nd Avenue overpass, empty syringe wrappers blanket the refuse like grass the used needles they once contained poking through like thistles. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
NEW YORK, NY - JUNE 07: 'Surfer' shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: A man leans against the wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Family members of those who died of opioid overdoses attend the 'Fed Up!' rally to end the opioid epidemic on at the National Mall on September 18, 2016 in Washington, DC. Activists and family members gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. (Photo by John Moore/Getty Images)
NEW YORK, NY - JUNE 07: A man rests against a wall appearing to be under the influence of drugs on a street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: Brian smokes a synthetic drug called K2 on the street in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
NEW YORK, NY - JUNE 07: 'Surfer' shoots heroin in a park in the South Bronx on June 7, 2017 in New York City. Like Staten Island, parts of the Bronx are experiencing an epidemic in drug use, especially heroin and other opioid based drugs. More than 1,370 New Yorkers died from overdoses in 2016, the majority of those deaths involved opioids. The Mott Haven-Hunts Point area of the Bronx borough of New York currently leads the city in heroin overdose deaths. According to the Deputy Attorney General, drug overdose are now the leading cause of death for Americans under the age of 50. (Photo by Spencer Platt/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a 'Fed Up!' rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States. (Photo by John Moore/Getty Images)
Quincy Massachusetts Police Detective Lt. Patrick Glynn holds a nasal injection containing the overdose-reversing drug naloxone at the police headquarters in Quincy, Mass., June 13, 2014. Quincy, Massachusetts, in 2010 became the first U.S. city to make the drug standard equipment for its police officers, who have used it to reverse some 275 overdoses, a significant number in a city of 93,000 people. Police forces nationwide are starting to follow suit. The state program has now moved far beyond police, training some 25,747 people in Massachusetts how to recognize the signs of opioid drug overdoses and administer naloxone. June 13, 2014. REUTERS/Gretchen Ertl (UNITED STATES - Tags: DRUGS SOCIETY HEALTH CRIME LAW)
A woman suspected of acting under the influence of heroine shows arms to police on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for smoking and injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for smoking and injecting drugs is seen after it was found during a police search on April 19, 2017, in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Paraphernalia for injecting drugs is seen after being found during a police search on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
Jessica, a homeless heroin addict, shows her kit of clean needles, mixing cap and tourniquet in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia's opioid epidemic. 80 percent of us want to get out,' said Jessica, before outlining the numerous ways she has tried to get treatment for her addiction. In one case, she said, there weren't any available beds. In another, a treatment provider required a positive drug test before delivering aid, meaning if she hadn't used recently she'd be denied. Instead of getting treatment, she spends her nights trying to keep warm on a mattress under a bridge, the very spot where she was raped and infected with HIV. People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
Drug paraphernalia and other garbage litter a vacant house on April 19, 2017 in Huntington, West Virginia. Huntington, the city in the northwest corner of West Virginia, bordering Kentucky, has been portrayed as the epicenter of the opioid crisis. On August 15, 2016, from 3:00 pm to 9:00 pm, 28 people in the city overdosed on heroin laced with fentanyl, a synthetic opioid far more powerful and dangerous than heroin. The economic incentives are powerful: one kilogram of fentanyl costs $5,000, which can make a million tablets sold at $20 each for a gain of $20 million. 'This epidemic doesn't discriminate,' Huntington Mayor Steve Williams said. 'Our youngest overdose was 12 years old. The oldest was 77.' / AFP PHOTO / Brendan Smialowski / TO GO WITH AFP STORY by Heather SCOTT, US-health-drugs-WestVirginia (Photo credit should read BRENDAN SMIALOWSKI/AFP/Getty Images)
A man injects himself in the foot with heroin near a heroin encampmentin the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia's opioid epidemic. At the camp, and throughout the nearby area, a user can buy a bag of high-grade heroin at a low price and even pay to have another person inject them if for any reason they are unable to inject themselves. For several individuals, the addiction process was a slow one that started with a doctor's prescription for pain pills after an accident or surgery, and by the time the medication was finished, a dependency was born. After seeking black-market pills to feed their addiction, the simple economics of heroin won out: the price of a single pill could fetch anywhere between 2 and 10 bags of heroin, a savings that's hard to ignore when an insurance company is no longer underwriting the cost. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Michael Botticelli, U.S. National Drug Control Policy Director, speaks at the 'Fed Up!' rally to end the opioid epidemic on September 18, 2016 in Washington, DC. Activists and family members of people who have died in the opioid and heroin epidemic gathered on the National Mall to march to the Capitol Building. Some 30,000 people die each year due to heroin and painkiller pill addiciton. Speakers called for Congress to provide $1.1 billion for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. (Photo by John Moore/Getty Images)
A man uses a syringe to gather the last drops from a scavenged water bottle to mix up a shot of heroin near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia?s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. People come from throughout the city, and some as far away as the Midwest, for heroin that is remarkably cheap and pure at the largest heroin market on the East coast. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
A Philadelphia Police officer patrols under a bridge near a heroin encampment in the Kensington neighborhood of Philadelphia, Pennsylvania, on April 14, 2017. In North Philadelphia, railroad gulch as it is known, is ground zero in Philadelphia��s opioid epidemic. The tracks and the surrounding property are owned and operated by the Consolidated Rail Corporation, a joint subsidiary of Norfolk Southern and CSX. Last month, Philadelphia Mayor Jim Kenney announced citations against the Consolidated Rail Corporation for what the mayor, in a release, said was Conrail's failure to clean and secure their own property.' Visitors and homeless residents of the gulch say the trash isn't their fault, and that they are only there because they have nowhere else to go. According to the city Health Commission, Philadelphia is on track to see 33 percent more drug overdose deaths in 2017 over last year. / AFP PHOTO / DOMINICK REUTER (Photo credit should read DOMINICK REUTER/AFP/Getty Images)
SANFORD, ME - FEBRUARY 16: Milo Chernin, who lost her son Sam to a heroin overdose on Jan. 16, 2017, looks at photos at her home in Sanford. She says that Sam, who died at age 25, struggled with his addiction and could not stay away from heroin despite getting treatment. (Photo by Derek Davis/Portland Press Herald via Getty Images)
WASHINGTON, DC - SEPTEMBER 18: Activists and family members of loved ones who died in the opioid/heroin epidemic take part in a 'Fed Up!' rally at Capitol Hill on September 18, 2016 in Washington, DC. Protesters called on legistlators to provide funding for the Comprehensive Addiction and Recovery Act, which Congress passed in July without funding. Some 30,000 Americans die each year due to heroin and painkiller pill addiciton in the United States. (Photo by John Moore/Getty Images)
GROTON, CT - MARCH 23: A box of the opioid antidote Naloxone, also known as Narcan, sits on display during a family addiction support group on March 23, 2016 in Groton, CT. The drug is used to revive people suffering from heroin overdose. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones' addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
NEW LONDON, CT - MARCH 23: A heroin user injects himself on March 23, 2016 in New London, CT. Communities throughout New England and nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
GROTON, CT - MARCH 23: Family members of people addicted heroin and opioid pain pills share stories during a support group on March 23, 2016 in Groton, CT. The group Communities Speak Out organizes monthly meetings at a public library for family members to talk about how their loved ones' addiction affects them and to give each other emotional support. Communities nationwide are struggling with the unprecidented heroin and opioid pain pill epidemic. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide, in an effort to curb the epidemic. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
NEW LONDON, CT - MARCH 14: Jackson, 27, who said he is addicted to prescription medication, lies passed out in a public library on March 14, 2016 in New London, CT. Police say an increasing number of suburban addicts are coming into the city to buy heroin, which is much cheaper than opioid painkillers. On March 15, the U.S. Centers for Disease Control (CDC), announced guidelines for doctors to reduce the amount of opioid painkillers prescribed nationwide. The CDC estimates that most new heroin addicts first became hooked on prescription pain medication before graduating to heroin, which is stronger and cheaper. (Photo by John Moore/Getty Images)
ST. JOHNSBURY, VT - FEBRUARY 06: 'Buck' who is 23 and addicted to heroin, shoots up Suboxone, a maintenance drug for opioid dependence that is also highly addictive on February 6, 2014 in St. Johnsbury, Vermont. Vermont Governor Peter Shumlin recently devoted his entire State of the State speech to the scourge of heroin. Heroin and other opiates have begun to devastate many communities in the Northeast and Midwest leading to a surge in fatal overdoses in a number of states. As prescription painkillers, such as the synthetic opiate OxyContin, become increasingly expensive and regulated, more and more Americans are turning to heroin to fight pain or to get high. Heroin, which has experienced a surge in production in places such as Afghanistan and parts of Central America, has a relatively inexpensive street price and provides a more powerful affect on the user. (Photo by Spencer Platt/Getty Images)
HIDE CAPTION
SHOW CAPTION
of
SEE ALL
BACK TO SLIDE

Alongside this worsening trend, opioid overdose admissions requiring treatment in hospital intensive care units (ICUs) surged 34 percent from 2009 to 2015, the study found. During this same period, the death rate for these ICU patients climbed from 7.3 percent to 9.8 percent.

“There are growing numbers of people who are so sick from their opioid overdose that they need ICU-level care, and despite everything we can do in the ICU more patients are dying in the ICU with complications from their overdose than ever before,” said lead study author Dr. Jennifer Stevens of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.

“So when we think of overdoses, we need not to just think about whether people died or survived, but also about the tremendous personal and societal costs of the serious medical problems that can come from overdoses for people who didn’t die, or didn’t die immediately,” Stevens said by email.

She and her colleagues examined data on more than 4.1 million patients admitted to ICUs in 162 hospitals in 44 states, including 21,705 with opioid overdoses, usually from heroin.

During the seven-year study period, the cost of caring for ICU patients who had opioid overdoses increased from $58,517 to $92,408 in 2015 dollars.

Among the opioid overdose patients, 25 percent experienced aspiration pneumonia, bacterial infections that happen when food, saliva or vomit is breathed into the lungs instead of remaining in the digestive tract.

The second most common complication was rhabdomyolysis, or the release of dead muscle fiber into the bloodstream, which occurred with 15 percent of the overdose patients in the ICU.

Eight percent of the patients had brain injuries and 6 percent had septic shock, a life-threatening response to infections that can cause serious organ damage.

One in ten people treated in the ICU after overdoses needed mechanical ventilation machines to help them breathe.

The study wasn’t designed to explain why more overdoses are being treated in ICUs. It’s possible that heightened awareness about overdoses is helping more people survive long enough to be admitted to the hospital. It’s also possible that people are having worse overdoses today than they did in the past, the researchers note.

Most likely, both possibilities are behind the surge in overdose patients in the ICU, said Dr. Marc LaRochelle, a researcher at Boston Medical Center’s Grayken Center for Addiction Medicine who wasn’t involved in the study.

“It likely reflects some contributions from at least two factors: one is increasing potency of opioid supply with a spike in illicit fentanyl in recent years,” LaRochelle said by email, referring to a fast-acting, highly potent prescription opioid that’s become a common recreational drug.

“A second would be more widespread overdose education and naloxone distribution programs,” LaRochelle added. Naloxone can block the effect of opioids and rapidly reverse the effects of an overdose.

“People who use injection drugs should obtain naloxone, the overdose reversal drug, and use drugs with partners who can help them,” said Brendan Saloner, a researcher at the Johns Hopkins Bloomberg School of Public Health in Baltimore who wasn’t involved in the study.

In many states, family members can get naloxone, sometimes without a prescription, Saloner said by email. Two medications, buprenorphine and methadone, can also help reduce drug use.

“There is unfortunately a lot of stigma about medication treatments, but they are safe and work,” Saloner added. “Long-term change is possible and recovery is a realistic goal, but it requires time and patience.”

Read Full Story