Opioid Use Disorder among Hospitalized Adults in North Carolina: Analysis from the 2000-2020 NC State Inpatient Database

Brook T. Alemu, Beth Harmer, Aaron Brown

Research output: Contribution to journalArticlepeer-review


Objective: Opioid use disorder (OUD) is characterized as a chronic condition outlined in the DSM-5, encompassing frequent opioid usage, the development of tolerance, withdrawal symptoms upon discontinuation, unsuccessful attempts to quit or reduce use, neglecting obligations, and forgoing activities in favor of drug consumption. Both national and state-level data show that overdose deaths associated with prescription opioids are increasing at an alarming rate. The increasing overdose deaths from illicitly manufactured fentanyls and other synthetic opioids compounds the burden of this epidemic. The current study sought to determine the prevalence and potential factors associated with OUD in North Carolina.
Methods: Using the State Inpatient Database (SID), a retrospective cross-sectional study was conducted to identify OUD-related discharges between 2000 and 2020. Descriptive statistics and rates of OUD per one thousand discharges were calculated. Simple and multivariable logistic regression models were used to identify factors associated with increased odds of having an opioid use disorder diagnosis at discharge. The deviance-Pearson (D-P) goodness of fit statistic was also employed. Variables were identified using ICD-9-CM and ICD-10-CM codes in the discharge records. The SID is a family of databases and software tools developed for the Healthcare Cost and Utilization Project (HCUP).
Results: Of 19,370,483 hospitalizations that occurred between 2000 and 2020 in North Carolina, 483,250 were associated with OUD, a prevalence rate of 24.9 cases per 1,000 discharges (95% CI: 24.8, 25.0). The highest OUD rates were seen among adults who self-paid for their hospitalization, those with Medicaid, and those with other types of payors such as Worker's Compensation and the Indian Health Service (49.0, 36.9, 41.7, respectively); individuals in the 35-44, 25-34, 45-54 age groups (38.6, 35.2, 34.3, respectively); tobacco and alcohol users (36.4, 30.3, respectively); Native Americans (35.2); patients located in urban areas (30.9); those with lower household income (33.4); white (33.4); and female patients (28.6). OUD was associated with increased odds of having one or more comorbid psychiatric disorders when controlling for other factors. Other comorbidities including hepatitis C (OR=6.3, 95% CI: 6.21-6.41), endocarditis (OR=3.4; 95% CI: 3.28-3.53), hypertension (OR=1.7; 95% CI:1.64-1.66), and other drug use (OR=9.6; 95% CI:9.42-9.73) were also strongly associated OUD. Further, adults with OUD had prolonged hospital stays (> 5 d) and significantly higher rates of mental health disorders (p < 0.05 for all).
Conclusions: Although preventative measures are crucial – including policies that discourage prescribing opioids for non-cancer pain and those that target the manufacturing and distribution of synthetic opioids, providing integrated care for patients with OUD and co-occurring psychiatric and/or physical disorders is equally important. These findings suggest the need for a system-wide public health response focused on the expansion of primary prevention and treatment efforts including crisis services, harm reduction services, and recovery programs.
Original languageAmerican English
JournalSouthern Medical Journal
StateAccepted/In press - 2024


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