Mortality Associated With Opioid Overdose: A Review of Clinical Characteristics and Health Services Received in the Year Prior to Death

UMMS Affiliation

Division of Addiction Psychiatry, Department of Psychiatry; Department of Quantitative Health Sciences; Department of Radiology; School of Medicine; Senior Scholars Program

Faculty Mentor

Gerardo Gonzalez

Publication Date


Document Type



Clinical Epidemiology | Epidemiology | Health Information Technology | Health Services Administration | Medical Education | Mental Disorders | Psychiatry | Psychiatry and Psychology | Substance Abuse and Addiction


OBJECTIVE:: To assess missed opportunities for reducing fatal opioid overdoses, characteristics of decedents by opioid overdose with and without problematic opioid use who received health care services within one year of death were examined.

METHODS:: Of 157 decedents in the Worcester, Massachusetts, area between 2008 and 2012, 112 had contact with the health care system. Electronic medical records were reviewed for clinical characteristics, health service use, universal precautions, and substance use disorder management. Problematic opioid use was defined as individuals having documented opioid use disorders or aberrant drug-related behavior. Data were analyzed with chi-square tests with adjusted residual for categorical variables and t tests for continuous variables.

RESULTS:: Decedents were predominantly Caucasian males with a mean+/-SD age of 41.0+/-11.7. Problematic opioid use by definition meant users (N=53) had opioid use disorder as a principal diagnosis and were likely to have a comorbid substance use disorder. Decedents with nonproblematic opioid use had diagnoses of chronic pain and mental illness. They were more likely to have been seen last in surgical and subspecialty settings (29% versus 11%). The proportion with an opioid prescription was higher among those with problematic use (72% versus 37%) who also had a higher total daily morphine equivalent, compared with those with nonproblematic use (165.4+/-282.7 versus 55.6+/-117.7 mg per day).

CONCLUSIONS:: Persons with problematic opioid use are a recognizable group with a high risk of death by opioid overdose whose therapeutic management needs improvement to reduce fatal outcomes. Different strategies must be developed for identifying and treating nonproblematic opioid use to reduce risk of death.


Medical morbidity and mortality in psychiatric patients, Mental health systems/hospitals, Opioid overdose, Overdoses

DOI of Published Version



Psychiatr Serv. 2019 Feb 1;70(2):90-96. doi: 10.1176/appi.ps.201800122. Epub 2018 Oct 24. Link to article on publisher's site

Journal/Book/Conference Title

Psychiatric services (Washington, D.C.)


Christian Rose participated in this study as a medical student as part of the Senior Scholars research program at the University of Massachusetts Medical School.

Related Resources

Link to Article in PubMed

PubMed ID