A recent population-based cohort study published in *CMAJ* has revealed critical insights into the dangers faced by patients who leave hospitals before completing their medical treatment.
Conducted in British Columbia, Canada, the study utilized administrative health data from over 189,000 hospital admissions between 2015 and 2019. It specifically examined patients who left the hospital prematurely and the outcomes they faced in the 30 days following their departure. Notably, the study found that overdose risks were significantly higher among those who left before completing their treatment.
Of the hospital admissions analyzed, 6440 patients (3.4%) left before receiving a physician-advised discharge. Among these patients, 183 experienced an overdose within the first 30 days—ten times the rate seen among those who were discharged as recommended by their doctors. The study found a strong association between BMA discharges and fatal or nonfatal drug overdoses, with the adjusted hazard ratio indicating a 58% higher risk of overdose compared to patients who followed medical advice.
The reasons patients chose to leave the hospital early varied, including undertreated pain, poorly managed opioid withdrawal symptoms, and psychological stress. These factors can lead patients—especially those with a history of substance use disorder—to relapse into drug use, increasing their vulnerability to overdose. The study highlights the complexity of managing substance use in medical settings and the challenges hospitals face in ensuring patients complete their treatments.
Moreover, the study's findings suggest that BMA discharge is often a marker of underlying social issues, such as homelessness and mental health conditions, which compound the medical risks. Patients leaving early were often *****er, male, and had a higher incidence of psychiatric and substance use disorders. The research suggests that disruptions in access to opioid agonist therapy (OAT) or withdrawal management during prolonged hospital stays can reduce drug tolerance, exacerbating the risk of overdose when patients resume drug use upon leaving.
The authors call for immediate improvements in hospital care for patients at risk of BMA discharge, particularly those with substance use disorders. Suggested interventions include ensuring access to OAT during hospitalization, better pain and withdrawal management, and providing culturally safe medical care to minimize the stigma that often drives premature discharges.
To reduce the post-discharge risks, the study recommends several strategies, such as providing take-home naloxone kits, improving post-discharge follow-up, and expanding access to supervised consumption services. The study also emphasizes the need for post-discharge outreach by healthcare providers to reduce the incidence of overdoses in this vulnerable population.
The study's findings are particularly timely as British Columbia continues to battle an overdose crisis, exacerbated by the prevalence of fentanyl in the illicit drug market. By identifying BMA discharge as a key risk factor for overdose, this research offers crucial data for developing targeted interventions to protect patients who might otherwise face life-threatening consequences shortly after leaving the hospital.
This study serves as a call to action for healthcare systems to refine discharge policies, offering more comprehensive support to patients struggling with substance use and other social determinants of health.
For further reading, the full study can be accessed here (clearnet).