Drug-related mortality after discharge from treatment: A record-linkage study of substance abuse clients in Texas, 2006–2012

Background: Patients have higher mortality immediately after substance abuse treatment discharge, but there are few data on post-discharge mortality differences across treatment modalities. Methods: A retrospective cohort study examined individuals discharged from substance abuse treatment during 2006–2012 and probabilistically matched treatment records to death records. Logistic regression examined associations between drug-related death (DRD) and demographics; route, frequency, and classes of drugs abused; and treatment. Primary outcome was DRD during post-discharge days 0–28; secondary outcomes examined DRD during days 29–90 and 91–365. Results: We examined 178,749 patients discharged from 254,814 treatment episodes. There were 97 DRD during days 0–28 (4.1/1000 person-years), 115 DRD during days 29–90 (2.6/1000 person-years; IRR 0.6 [95% CI 0.5–0.8]), and 293 DRD during days 91–365 (1.9/1000 person-years; IRR 0.5 [0.4–0.6]). Higher 28-day DRD was associated with abuse of opioids (aOR 2.5 [1.4–4.4]), depressants (aOR 2.0 [1.2–3.4]), or alcohol (aOR 1.7 [1.1–2.6]); and opioid injection (aOR 2.2 [1.3–3.7]). Lower DRD was associated with treatment completion (aOR 0.6 [0.4–0.9]), female sex (aOR 0.6 [0.4–0.8]), and employment (aOR 0.5 [0.3–0.9]). Among all patients, DRD rates were higher following residential (IRR 2.6, [1.6–4.2]) and detoxification (IRR 2.9, [1.7–4.9]) treatment compared to outpatient. Patients with prior opioid abuse had higher 28-day DRD after outpatient (6.7/1000 person-years; IRR 4.1 [1.8–9.1]), residential (13.6/1000 person-years; IRR 4.2 [2.2–8.2]), and detoxification (8.8/1000 person-years; IRR 3.2 [1.2, 8.5]) compared to those without. Conclusions: Drug-related mortality is highest during days 0–28 after discharge, especially following residential and detoxification treatment. Opioid abuse is strongly associated with early post-discharge mortality.