Inpatient admissions in people with opioid dependence: a portuguese population-based observational retrospective study

Background:

Epidemiological studies conducted over recent years underscore a diminishing prevalence of opioid use in Portugal compared to other substances. Despite this overall trend, opioid dependence persists as a significant issue within the realm of problematic consumption. Moving beyond the numerical representation of opioid prevalence, this study addresses the critical concern of how opioid addiction influences morbidity among inpatients by assessing the hospitalization episodes exhibiting a higher prevalence of opioid dependence as a secondary diagnosis.

Methods:

This population-based observational retrospective study utilized a comprehensive Portuguese administrative database encompassing all mainland public hospitalizations. Employing the International Classification of Diseases Version 9 (ICD-9), we analyzed hospitalization episodes spanning from 2008 to 2015 with a secondary diagnosis of opioid dependence (code 304.0) with the total number of inpatient episodes being evaluated based on the primary diagnosis. Statistical analysis was executed using Excel.

Results:

Over the 8-year study period, a total of 12,356 hospitalization episodes with a secondary diagnosis of opioid dependence were identified. On average, there were 1,545 episodes annually (± 109), with 2008 (1,669, 13.5%) and 2010 (1,415, 11.5%) recording the highest and lowest episode numbers, respectively. Primary diagnoses within the "Infectious And Parasitic Diseases" category of the ICD-9 were the most prevalent (24.5%), with 18.7% of total episodes having Human Immunodeficiency Virus [HIV] disease as the primary diagnosis. Other prevalent primary diagnosis groups included "Diseases of the Respiratory System" (15.0%), "Diseases of the Digestive System" (11.3%) and "Mental Disorders" (9.0%). Particularly within the "Mental Disorders" group, those registered with "Other and unspecified alcohol dependence," "Paranoid type schizophrenia, chronic with acute exacerbation," and "Unspecified psychosis," as primary diagnoses exhibited higher rates of opioid dependence as a secondary diagnosis.

Conclusions:

There were a few notable limitations to this work: the utilization of data recorded for administrative purposes rather than research intent, a limited timeframe and the focus on hospitalization episodes rather than individual patients. While the total yearly hospitalizations with opioid dependence as a secondary diagnosis remained consistent, certain medical conditions such as HIV, respiratory diseases or mental disorders displayed a higher prevalence of opioid dependence as a secondary diagnosis. This not only poses challenges to overall health but also contributes to various medical complications for these hospitalized individuals. Understanding and exploring this impact is therefore crucial for formulating effective intervention and treatment strategies, with the ultimate goal of promoting not only physical and mental recovery but also a successful societal reintegration.