The mortality rate for patients hospitalized for opioid-related conditions more than quadrupled between 2000 and 2014, with increases in admissions related to opioids among whites, people aged 50 to 64, Medicare beneficiaries with disabilities and people from lower-income areas.

The study published in the December 2017 issue of Health Affairs found while the death rate among opioid hospitalizations rose from 0.43 percent to 2.02 percent from 2000 to 2014, the total number of those hospitalizations was steady over the time frame. Study author Zirui Song, MD, PhD, assistant professor at Harvard Medical School and internal medicine physician at Massachusetts General Hospital, said there was a shift in the severity of those admissions, with hospitalizations related to overdoses of opioids and heroin growing at the same pace as the decrease in hospitalizations for dependence and abuse.

At the same time, mortality rates among hospitalizations for other drugs, such as alcohol and cocaine, remained stable throughout the study period, averaging 0.75 percent after 2000. While other studies have suggested deaths related to opioids and prescription opioid abuse plateaued several years ago, Song found in-hospital mortality rates for opioids have continued to climb.

“The fact that patients who are hospitalized may fare worse is consistent with the increasing severity of opioid abuse, especially among vulnerable and disabled populations,” Song wrote.

The fastest-growing segments for hospitalizations were centered around “middle-aged, socioeconomically disadvantaged white populations,” including Medicare beneficiaries younger than age 65 who likely receive disability benefits—and 40 percent of that population use prescription opioids, which have been blamed for the healthcare industry’s role in fueling the opioid epidemic.

Song offered three possible explanations for these trends which push the blame away from opioid prescribers. One is the availability of more potent opioids like fentanyl, which can be “50 to 100 times as strong as heroin.” Another is users switching from expensive prescription opioids to cheaper heroin. A final possibility, Song wrote, is the response to the opioid epidemic has changed where some overdoses are handled.

“Less severe cases of opioid poisoning may have been increasingly treated in the field, outpatient settings or the emergency department, thus leaving a greater proportion of more severe cases for inpatient admission,” Song wrote.

In his conclusion, Song said federal funding to tackle opioid abuse may have varying effects across the country. He added that restrictions on opioid prescribers and dispensers haven’t been associated with reduced rates of abuse or overdose. If community-based efforts haven’t taken told, he said the way to combat rising mortality rates for opioid hospitalizations would be to focus on addiction treatment and “better equipping hospitals to care for patients with increasingly severe opioid abuse.”