New Risk Tools Aim to Prevent Overdose Deaths After Early Hospital Discharge

Research published in the Canadian Medical Association Journal suggests that risk prediction tools could significantly improve patient safety by identifying individuals at heightened risk of overdose and death following a “before medically advised” (BMA) hospital discharge. Patients who leave the hospital against their physician’s advice face a much greater likelihood of adverse outcomes, being approximately twice as likely to die and ten times more likely to suffer an illicit drug overdose within the first 30 days of discharge.

Each year, around 500,000 people in the United States and 30,000 people in Canada opt for BMA discharges. Dr. Hiten Naik of the University of British Columbia and his co-authors advocate for integrating risk assessments with clinical judgment to facilitate discussions about the appropriateness of BMA discharges. They argue that tailoring conversations to assess a patient’s decision-making capacity and exploring ways to mitigate risks could lead to better outcomes.

Understanding the Research Findings

The research team developed two distinct risk prediction models. The first aims to estimate the risk of death from any cause in the 30 days following a BMA discharge, while the second focuses on patients with a history of substance use, estimating their risk of illicit drug overdose. By analyzing data from British Columbia, the study examined two cohorts: cohort A comprised of 6,440 adults from the general population, and cohort B included 4,466 individuals with a history of substance use.

In cohort A, the researchers discovered that death was less frequent than anticipated, with only one death occurring for every 63 BMA discharges. Significant predictors of mortality included multimorbidity, heart disease, and cancer. Conversely, cohort B revealed that certain social and health factors, such as homelessness, reliance on income assistance, and a history of drug overdose, were strong indicators of the risk of overdose following a BMA discharge.

The findings indicate that among those with a history of substance use, illicit drug overdoses occurred at a concerning rate, with roughly one overdose for every 19 BMA discharges. The authors emphasize that this period represents a crucial opportunity for overdose prevention, suggesting that healthcare systems could implement automated alerts for higher-risk patients.

Implications for Healthcare Systems

Dr. Naik and his colleagues propose that hospitals could leverage these risk prediction models to improve support for vulnerable patients. By automating the assessment process for individuals at higher risk of adverse outcomes, healthcare providers could ensure timely enrollment in support programs and enhance monitoring efforts.

“These models offer a starting point for identifying patients who are high risk and may benefit from greater support,” the authors note. They assert that by reducing uncertainty in the decision-making process, healthcare professionals might experience less moral distress when faced with BMA discharge situations.

This research underscores the importance of understanding the complexities surrounding early hospital discharges and the potential benefits of risk assessment tools in preventing overdose and mortality. As healthcare systems continue to evolve, integrating these predictive models could play a pivotal role in safeguarding patient health post-discharge.

For further details, consult the article titled “Predicting drug overdose and death after ‘before medically advised’ hospital discharge” in the Canadian Medical Association Journal, published in 2025.