Patients discharged from hospitals against medical advice are at significantly increased risk of overdose and death, according to a study published in the Canadian Medical Association Journal. Research conducted by a team led by Dr. Hiten Naik from the University of British Columbia highlights that individuals who leave hospital early without physician approval are twice as likely to die and ten times more likely to experience an illicit drug overdose within the first 30 days post-discharge.
Every year, approximately 500,000 patients in the United States and 30,000 in Canada opt for early discharge, often referred to as “before medically advised” (BMA) discharges. The study emphasizes the importance of identifying those at highest risk in order to provide better support and guidance.
Understanding Risk Factors
The researchers developed two predictive models aimed at estimating the risk of death and drug overdose in patients who initiate BMA discharges. The first model assesses the overall risk of death from any cause within 30 days, while the second focuses specifically on patients with a history of substance use. Analyzing data from British Columbia, the team assessed two cohorts: one consisting of 6,440 adults from the general population and another with 4,466 individuals who had a history of substance use.
In the general population cohort, the study found that the actual rate of death was lower than expected, with only one death occurring for every 63 BMA discharges. However, factors such as multimorbidity, heart disease, and cancer were significant predictors of mortality within this timeframe.
In contrast, the cohort with a history of substance use presented alarming statistics. Researchers discovered that illicit drug overdose occurred at a rate of approximately one overdose for every 19 BMA discharges, underscoring the critical need for targeted interventions during this vulnerable period.
Implications for Healthcare Systems
The authors suggest that hospitals and healthcare systems could leverage these risk prediction models to enhance the management of higher-risk BMA discharges. By implementing automated alerts and enrolling patients in support programs, healthcare providers can offer necessary assistance and reduce the likelihood of adverse outcomes.
“Calculating a specific patient’s risk of death and drug overdose—combined with clinical judgment and other risk scores—might help clinicians and patients have a constructive, patient-centered discussion,” Dr. Naik states. This approach could also alleviate moral distress among clinicians faced with the challenging decision of discharging patients against medical advice.
The study advocates for a shift in how healthcare providers approach BMA discharges, emphasizing that this period represents a largely unexplored opportunity for overdose prevention. Implementing these risk prediction tools could ultimately lead to better health outcomes for vulnerable patients post-discharge.
The findings and recommendations from this research offer a critical starting point for improving patient safety and support following early hospital discharge. More details can be found in the study titled, “Predicting drug overdose and death after ‘before medically advised’ hospital discharge,” in the Canadian Medical Association Journal (2025).
