{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:24:27Z","timestamp":1791469467441,"version":"4.3.4"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T00:00:00Z","timestamp":1633392000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["DRF- 2018-11-ST2-016"],"award-info":[{"award-number":["DRF- 2018-11-ST2-016"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002977","name":"Dalhousie University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002977","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["171259"],"award-info":[{"award-number":["171259"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R25DA033211"],"award-info":[{"award-number":["R25DA033211"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Hospital patients who use illicit opioids such as heroin may use drugs during an admission or leave the hospital in order to use drugs. There have been reports of patients found dead from drug poisoning on the hospital premises or shortly after leaving the hospital. This study examines whether hospital admission and discharge are associated with increased risk of opioid-related death.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We conducted a case-crossover study of opioid-related deaths in England. Our study included 13,609 deaths between January 1, 2010 and December 31, 2019 among individuals aged 18 to 64. For each death, we sampled 5 control days from the period 730 to 28 days before death. We used data from the national Hospital Episode Statistics database to determine the time proximity of deaths and control days to hospital admissions. We estimated the association between hospital admission and opioid-related death using conditional logistic regression, with a reference category of time neither admitted to the hospital nor within 14 days of discharge. A total of 236\/13,609 deaths (1.7%) occurred following drug use while admitted to the hospital. The risk during hospital admissions was similar or lower than periods neither admitted to the hospital nor recently discharged, with odds ratios 1.03 (95% CI 0.87 to 1.21; <jats:italic>p<\/jats:italic> = 0.75) for the first 14 days of an admission and 0.41 (95% CI 0.30 to 0.56; <jats:italic>p<\/jats:italic> &lt; 0.001) for days 15 onwards. 1,088\/13,609 deaths (8.0%) occurred in the 14 days after discharge. The risk of opioid-related death increased in this period, with odds ratios of 4.39 (95% CI 3.75 to 5.14; <jats:italic>p<\/jats:italic> &lt; 0.001) on days 1 to 2 after discharge and 2.09 (95% CI 1.92 to 2.28; <jats:italic>p<\/jats:italic> &lt; 0.001) on days 3 to 14. 11,629\/13,609 deaths (85.5%) did not occur close to a hospital admission, and the remaining 656\/13,609 deaths (4.8%) occurred in hospital following admission due to drug poisoning. Risk was greater for patients discharged from psychiatric admissions, those who left the hospital against medical advice, and those leaving the hospital after admissions of 7 days or more. The main limitation of the method is that it does not control for time-varying health or drug use within individuals; therefore, hospital admissions coinciding with high-risk periods may in part explain the results.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Discharge from the hospital is associated with an acute increase in the risk of opioid-related death, and 1 in 14 opioid-related deaths in England happens in the 2 weeks after the hospital discharge. This supports interventions that prevent early discharge and improve linkage with community drug treatment and harm reduction services.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003759","type":"journal-article","created":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T17:24:55Z","timestamp":1633454695000},"page":"e1003759","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":50,"title":["Fatal opioid overdoses during and shortly after hospital admissions in England: A case-crossover study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3698-7196","authenticated-orcid":true,"given":"Dan","family":"Lewer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1485-5571","authenticated-orcid":true,"given":"Brian","family":"Eastwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3110-4342","authenticated-orcid":true,"given":"Martin","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-5556","authenticated-orcid":true,"given":"Thomas D.","family":"Brothers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McCusker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4462-1402","authenticated-orcid":true,"given":"Caroline","family":"Copeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7008-8130","authenticated-orcid":true,"given":"Michael","family":"Farrell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0037-7524","authenticated-orcid":true,"given":"Irene","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,5]]},"reference":[{"key":"pmed.1003759.ref001","doi-asserted-by":"crossref","first-page":"e0229713","DOI":"10.1371\/journal.pone.0229713","article-title":"Illicit drug use while admitted to hospital: Patient and health care provider perspectives","volume":"15","author":"C Strike","year":"2020","journal-title":"PLoS ONE"},{"key":"pmed.1003759.ref002","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/j.1365-2524.2007.00739.x","article-title":"Barriers to accessing generic health and social care services: a qualitative study of injecting drug users: Drug injectors and barriers to service use","volume":"16","author":"J Neale","year":"2007","journal-title":"Health Soc Care Community"},{"key":"pmed.1003759.ref003","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.socscimed.2014.01.010","article-title":"Hospitals as a \u2018risk environment\u2019: An ethno-epidemiological study of voluntary and involuntary discharge from hospital against medical advice among people who inject drugs","volume":"105","author":"R McNeil","year":"2014","journal-title":"Soc Sci Med"},{"key":"pmed.1003759.ref004","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s12954-019-0285-7","article-title":"Maybe if I stop the drugs, then maybe they\u2019d care?\u201d\u2014hospital care experiences of people who use drugs.","author":"S Chan Carusone","year":"2019","journal-title":"Harm Reduct J"},{"key":"pmed.1003759.ref005","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.jsat.2018.06.011","article-title":"In-hospital illicit drug use, substance use disorders, and acceptance of residential treatment in a prospective pilot needs assessment of hospitalized adults with severe infections from injecting drugs","volume":"92","author":"LC Fanucchi","year":"2018","journal-title":"J Subst Abuse Treat"},{"key":"pmed.1003759.ref006","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1111\/dar.12270","article-title":"Illicit drug use in acute care settings","volume":"34","author":"HK Grewal","year":"2015","journal-title":"Drug Alcohol Rev"},{"key":"pmed.1003759.ref007","article-title":"Dead patient lay undiscovered for THREE NIGHTS in an NHS hospital toilet \u2018after drug overdose.\u2019 The Sun","author":"Sun Reporter","year":"2017"},{"key":"pmed.1003759.ref008","article-title":"Patient who lay dead in a hospital toilet for two days wasn\u2019t even reported missing until over FOUR HOURS after he left his ward for a cigarette","author":"Z. 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JAMA Intern Med"},{"key":"pmed.1003759.ref031","first-page":"193","article-title":"Caring for people who inject drugs when they are admitted to hospital","author":"TD Brothers","year":"2021","journal-title":"CMAJ."},{"key":"pmed.1003759.ref032","volume-title":"ACMD report: ageing cohort of drug users","author":"Advisory Council on the Misuse of Drugs","year":"2019"},{"key":"pmed.1003759.ref033","doi-asserted-by":"crossref","first-page":"113183","DOI":"10.1016\/j.socscimed.2020.113183","article-title":"Normalised pain and severe health care delay among people who inject drugs in London: Adapting cultural safety principles to promote care","volume":"260","author":"M. Harris","year":"2020","journal-title":"Soc Sci Med"}],"container-title":["PLOS Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003759","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,5]],"date-time":"2021-10-05T17:25:27Z","timestamp":1633454727000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmed.1003759"}},"subtitle":[],"editor":[{"given":"Vikram","family":"Patel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,5]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmed.1003759","relation":{},"ISSN":["1549-1676"],"issn-type":[{"value":"1549-1676","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,5]]}}}