New Risk Tools Aim to Prevent Overdose and Death Post-Hospital Discharge

Research published in the Canadian Medical Association Journal indicates that risk prediction tools could significantly improve outcomes for patients who leave the hospital against medical advice. Patients discharged “before medically advised” (BMA) face alarming risks, including a two-fold increase in mortality and a ten-fold increase in the likelihood of experiencing an illicit drug overdose within the first 30 days post-discharge. Approximately 500,000 individuals in the United States and 30,000 in Canada choose to leave hospitals under these circumstances each year.

Dr. Hiten Naik from the University of British Columbia, along with co-authors, highlights the importance of evaluating a patient’s specific risk of overdose and death in conjunction with clinical judgment. This approach can foster a more constructive conversation between clinicians and patients regarding the decision to proceed with a BMA discharge. The research team suggests that informing patients about these risks may also alleviate the moral distress healthcare providers often face when confronted with BMA discharges.

Developing Risk Prediction Models

The study involved two risk prediction models. One model assesses the likelihood of death from any cause within 30 days of a BMA discharge, while the other focuses specifically on patients with a history of substance use, estimating their risk of illicit drug overdose. Data from British Columbia provided the basis for this research, which examined two cohorts: cohort A included 6,440 adults from the general population who initiated a BMA discharge, and cohort B comprised 4,466 individuals with a history of substance use.

In cohort A, researchers discovered that deaths occurred less frequently than expected, with a ratio of one death within 30 days for every 63 BMA discharges. Notably, factors such as multimorbidity, heart disease, and cancer emerged as strong predictors of mortality in this group. Conversely, cohort B revealed that homelessness, reliance on income assistance, and a history of drug overdose significantly increased the risk of overdose following a BMA discharge. The findings indicated that for patients with a history of substance use, the likelihood of experiencing an illicit drug overdose soon after a BMA discharge was notably high—approximately one overdose for every 19 discharges.

Opportunities for Overdose Prevention

The authors emphasize that the period immediately following a BMA discharge presents a critical, yet largely overlooked, opportunity for overdose prevention. They advocate for hospitals and health systems to integrate these risk prediction models into their discharge protocols. By automating the identification of high-risk patients, healthcare facilities can issue alerts and facilitate automatic enrollment in support programs designed to mitigate risks.

Dr. Naik and his colleagues believe these models represent a starting point for identifying those at elevated risk who may benefit from enhanced support. The research underscores the potential for improved health outcomes through targeted interventions, ultimately aiming to reduce the alarming rates of overdose and mortality associated with early hospital discharges.

For further information, refer to the article “Predicting drug overdose and death after ‘before medically advised’ hospital discharge” published in the Canadian Medical Association Journal (2025). DOI: 10.1503/cmaj.250492.