Opioid overdose following surgery or pain treatment: A missed opportunity for intervention

Background: British Columbia has been the epicentre of the opioid overdose crisis since declaring it a provincial public health emergency in 2016. Effective strategies to reduce mortality are currently lacking. Methods: This retrospective observational study included patients who presented to local emergency departments with opioid overdose during a 12-month period (1 July 2018 to 30 June 2019). We extracted demographics and overdose history and characterized hospital visits for pain or surgery within 24 months prior to the overdose. Results: We identified 1104 patients who presented with overdose, of which 77% were male (n = 854), with a mean age of 41 across all patients (SD = 12). Within 24 months prior to the overdose, 50% of the cohort had a health care encounter for pain, and 5% had presented for surgery or a surgical procedure. Most patients (57%) had experienced a prior overdose (median = 2 prior overdoses; range = 1 to 28). Patients who had a prior health care encounter for pain or surgery were more likely to have had a previous overdose than those who did not have an encounter (66% vs 47%, respectively; P <.00001). Among those who had a previous overdose, there was a significant association between having prior pain or surgery visits and multiple prior overdoses (P =.0006). Conclusions: Prior health care encounters for pain and surgery are common among people who present with opioid overdose. These visits are opportunities to prevent repeat overdoses, recurring health visits, and premature death.