Heroin overdose trends in a high volume urban emergency department over a 4-year period: 2014-2017
Baltarowich L, Dean D, Fontana J, Akram A, Shayya S, and Miller J. Heroin overdose trends in a high volume urban emergency department over a 4-year period: 2014-2017. Journal of Medical Toxicology 2020; 16(2):142.
Journal of Medical Toxicology
Background: Urban emergency departments (ED) have experienced increasing visits for heroin overdoses since 2014, with noted federal reports that most involve heroin adulterated with fentanyl. Our study objective was to characterize this evolving trend in an urban trauma center ED from 2014 to 2017. Methods: This is a retrospective observational study of ED patients from 2014 to 2017 with a diagnosis of heroin overdose. Patients in cardiac arrest were excluded. Trained abstractors collected standardized data on clinical information, substance use, and ED disposition. We assessed changes in overdose patterns over time and compared characteristics of admitted and discharged patients. Analysis included descriptive statistics and generalized linear or mixed models where appropriate. Results: A total of 900 patients were included. The incidence of heroin overdose visits increased twofold between 2015 and 2016 and threefold between 2014 and 2017. During the overall period, 73% of patients were discharged from ED, 11% left AMA, and 16% were admitted. Mean LOS in ED was 6.6 hours. The mean age increased from 47.7 years in 2014 to 50 in 2017 (p < 0.01). Gender, race, and ED disposition did not change significantly. Concomitant drugs on urine screens were opiates 87%, cocaine 46%, benzos 35%, THC 31%, and ethanol 23%. Comparison of admitted and discharged patients showed similar age, gender, and race. Admitted patients were more likely to have concomitant amphetamine use (p = 0.037) and less likely THC (p = 0.006); 14% of admitted patients required ICU care. Respiratory compromise was the most common complication; 66% of patients with an abnormal chest X-ray had pneumonia or pulmonary edema. Conclusion: This study shows a significant increase in ED patient visits for heroin overdose from 2014 to 2017 with increasing mean age over time. Most patients were discharged from the ED, and of those admitted, the majority went to non-ICU beds.