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Background: Due to an increase in the number of opioid overdose deaths locally, we began distributing intranasal naloxone to Public Health – Seattle & King County STD Clinic patients who reported injecting heroin in the prior year. The objective of this study was to evaluate the risk and timing of opioid-associated mortality among clinic patients to assess the number of potentially avertable deaths.
Methods: We matched WA State Death Certificate data, which distinguish opioid-involved from opioid-involved accidental poisoning (overdose) deaths, with STD Clinic data from 1993-2014. We used routinely collected clinic data to identify patient-report of lifetime injection drug use (IDU). We calculated crude and age-adjusted mortality rates for opioid-involved deaths by self-reported IDU status. Person-time was defined as the time between first clinic visit and either death or 12/31/14.
Results: In 1993-2014, there were 298,438 clinic visits among 112,971 unique patients; 7865 (7%) reported IDU at any visit. Of 979,179 WA State deaths, 2702 were persons seen in the STD Clinic and 322 (12%) were opioid-involved. Of the 292 patients who died of an opioid overdose, 156 (53%) did and 136 (47%) did not report IDU at the clinic. Thus, 2% (156/7865) of IDU-reporting clinic patients died of an overdose, an average of 7 patients per year. Age-adjusted overdose mortality was 15-fold higher among IDU-reporting than non-reporting patients (154.5 vs. 10.5/100,000 person-years). In 2007-2014, a total of 143 overdose deaths occurred: 12 (9%) ≤1 year, 37 (26%) 1-4 years, and 93 (65%) ≥5 years after the last clinic visit.
Conclusions: We found substantial mortality from opioid overdose among IDU-reporting STD Clinic patients, but the majority of deaths occurred several years after the visit. Distribution of naloxone in the clinic is unlikely to prevent many overdose deaths among patients, but may help diffuse the intervention into the community.