New Risk Models Identify Patients at High Risk of Overdose

Patients discharged from hospitals against medical advice face significantly increased risks of overdose and death, according to recent research published in the Canadian Medical Association Journal. The study highlights how risk prediction tools can be instrumental in identifying individuals most vulnerable to these outcomes after a “before medically advised” (BMA) discharge.

Each year, approximately 500,000 individuals in the United States and 30,000 in Canada choose to leave the hospital against their physician’s guidance. Those who do so are about twice as likely to die and ten times more likely to suffer an illicit drug overdose within the first 30 days post-discharge.

Understanding the Risks

The research team, led by Dr. Hiten Naik from the University of British Columbia, developed two risk prediction models. One model estimates the overall risk of death within 30 days of a BMA discharge, while the other focuses specifically on patients with a history of substance use to predict the likelihood of illicit drug overdoses.

In their analysis, researchers examined data from British Columbia, assessing two distinct cohorts. Cohort A consisted of 6,440 adults from the general population, while cohort B included 4,466 individuals with a history of substance use. Among cohort A, the study found that death occurred less frequently than expected, with an average of one death for every 63 BMA discharges. Key predictors of mortality included multimorbidity, heart disease, and cancer.

In contrast, cohort B revealed that certain social and health factors significantly increased the risk of overdose. Homelessness, income assistance dependence, and a history of substance use disorders were strong indicators of potential drug-related incidents post-discharge. The research indicated that around one illicit drug overdose occurred for every 19 BMA discharges in this group, underscoring the critical need for targeted interventions during this vulnerable period.

Implications for Healthcare Providers

The authors emphasize that understanding these risks can foster more productive discussions between healthcare providers and patients regarding BMA discharges. They suggest that assessing a patient’s capacity to make informed decisions about their discharge, combined with risk estimates, can help mitigate potential hazards.

“By reducing uncertainty, risk estimates might also reduce clinician moral distress when faced with a BMA discharge,” Dr. Naik and his co-authors write. They propose that healthcare systems could implement these risk prediction models to streamline processes for discharging high-risk patients, potentially incorporating automated alerts and enrollment in support programs.

Such proactive measures could be crucial for improving patient outcomes and preventing overdose incidents following hospital release. The findings present a compelling case for integrating risk assessment tools in hospital discharge protocols, thus enhancing the overall quality of care for at-risk populations.

For further details, refer to the study titled “Predicting drug overdose and death after ‘before medically advised’ hospital discharge,” published in the Canadian Medical Association Journal in 2025. The DOI for the study is 10.1503/cmaj.250492.