Project 461249

People who use illicit drugs are more likely to discharge themselves from hospital even when their doctor tells them they require ongoing hospital care. This is called 'discharge against medical advice'. The risk of drug overdose might be higher in the days following discharge against medical advice because these individuals are often still very sick and might have lower tolerance for drugs than they did prior to their hospitalization. Overdose risks in the days after discharge against medical advice aren't well understood because they haven't been studied before. British Columbia (BC) has been one of the hardest-hit provinces in the overdose crisis. Most drug overdoses in BC involve opioids. Our study will use hospitalization data from BC to examine whether people are more likely to overdose after discharge against medical advice. We will also examine risk factors for overdose after discharge against medical advice, including whether medications prescribed to treat opioid use disorder (such as methadone and Suboxone) reduce the risk of overdose. Finally, we will examine whether discharge against medical advice increases the risk of emergency department use, hospital readmission, overdose death, or death from any cause. To complete our study, we will analyze the real-world health data of about 200,000 British Columbians hospitalized between 2015 and 2019. The data has had names and other identifying features removed to protect the identity of individuals. This data has previously been used by public health researchers to inform BC's response to the opioid overdose crisis. Our results will help doctors and public health officials design programs to prevent overdose and potentially save lives.