As heroin overdoses soar, so do hospital ICU costs

Hospital costs for some of the most expensive treatments following an overdose are rising swiftly, researchers report, as intensive-care unit doctors struggle to save patients who arrive in increasingly dire straits. Overdose-related ICU admissions in Pennsylvania nearly doubled between 2009 and 2015.

The data, from Pennsylvania and 43 other states, suggest that heroin has become a far more dangerous challenge, at least in the ICU, than the prescription painkillers with which most new heroin users started. Mortality in the ICU from prescription painkiller-related overdoses has remained more or less flat for several years while nearly tripling among patients who were admitted after a heroin overdose.

Overall, about 7 percent of overdose patients admitted to the ICU died in 2009, rising to 10 percent in 2015, which was before the dramatic increase in deadly fentanyl combined with heroin and other drugs hit the streets.

Overdose patients who are quickly revived on-site with the emergency reversal medication naloxone, typically by fellow users or first responders, may experience minimal injury and often refuse a ride to the hospital to be checked over. But those who stopped breathing for even a few minutes can suffer serious brain damage, as did 8 percent of overdose patients in the ICU. About 25 percent had aspiration pneumonia, a lung infection that can develop from inhaling food, liquid, or vomit. Both contributed to an average length of stay in the ICU of seven to 10 days — and a cost that rose from $58,517 per admission in 2009 to $92,408 in 2015, a 58 percent increase in inflation-adjusted dollars.

For the study, published this month in Annals of the American Thoracic Society, researchers at Harvard, the University of Chicago, and Ben-Gurion University of the Negev in Israel analyzed discharge data on 4,100 ICU admissions for overdose at 162 hospitals in 44 states between Jan. 1, 2009 and Sept. 31, 2015. They relied on a database that consists mostly of urban academic hospitals, and so would overrepresent places like Philadelphia and Pittsburgh and underrepresent rural areas.

Still, they said their study appeared to be the first attempt to measure the impact of opioid abuse on critical care resources nationwide. "We would propose that any admission to the ICU for opioid overdose is a preventable admission," they wrote, adding that the "findings represent a growing and urgent call for additional critical care resources and expanded primary prevention strategies."

The researchers found an average 34 percent increase in opioid overdose-related ICU admissions over the period studied. An additional analysis of eight large states found that Pennsylvania's admissions rate was more or less typical in 2015 but had increased 89 percent over the nearly seven-year period, the most in the group.

That finding is in line with other data, such as national mortality statistics showing that Pennsylvania's rate of overdose deaths from all drugs rose nearly twice as fast as the national average in 2015, the latest year available, placing the state's death rate sixth-highest nationwide. (New Jersey's rate increased somewhat faster as well, bringing it in line with the national average. It was not one of the eight states broken out in the new study.)

"In conclusion," the authors wrote, "there is substantial demand for critical care resources secondary to the opioid overdose epidemic in the United States. Early recognition for states with rising crises — such as Pennsylvania — may allow for early action in these areas to both prepare critical care units for the needs of this population and to better equip front line providers to prevent these critical care admissions from occurring."