TOPLINE

Patients discharged from the emergency department (ED) after stimulant toxicity had a 1-year mortality rate of 2.1%, which was approximately 14 times higher than the rate among people of similar age in the general population. Overdose was the cause of about two thirds of deaths, and opioids contributed to more than half of these overdose-related deaths.

METHODOLOGY

• A retrospective cohort study analyzed records of 2356 patients discharged directly from the ED between 2018 and 2023, with stimulant toxicity as the primary diagnosis. 
• Stimulant toxicity was identified using International Classification of Diseases, Tenth Revision (ICD-10) codes for cocaine, amphetamines, methamphetamines, methylenedioxymethamphetamine, methylphenidate, other psychostimulants, and synthetic cannabinoids.
• Researchers estimated the risk for death from any cause within 1 year after ED discharge. Causes of death were determined using ICD-10 codes from state death records.
• Researchers also estimated 1-year mortality in a reference group of 1665 patients discharged after an ED visit for opioid toxicity.

TAKEAWAY

• A total of 46 patients died within 1 year of ED discharge; the estimated mortality rate was 2.1%. The median time from the ED visit to death was 118 days, and the median age of decedents at the index visit was 35 years.  
• Methamphetamines/ amphetamines were responsible for 54% of index diagnoses, and cocaine was responsible for 24%.
• Among patients who died within 1 year, 67% died of overdose; opioids were involved in 54% of overdose-related deaths and stimulants in 48%, with both substances involved in 37% of these deaths.
• In the reference cohort of 1665 patients with opioid toxicity, 1-year mortality was 6.9%, and the median time from the ED visit to death was 174 days.

IN PRACTICE

"ED encounters for stimulant toxicity identify patients at increased risk of subsequent mortality. Deaths were predominantly overdose-driven and frequently opioid-involved, suggesting that these encounters may represent an important opportunity for opioid-focused harm reduction and overdose prevention," the authors wrote.

SOURCE

The study was led by Damilola Idowu, MD, Medical College of Wisconsin, Milwaukee. It was published online on October 23, 2026, in The American Journal of Emergency Medicine.

LIMITATIONS

Stimulant-related ED visits were identified using ICD-10 codes, potentially resulting in missed cases and the inclusion of visits not primarily attributable to stimulant use. Deaths were matched using a hashed identifier generated from patients' names, dates of birth, and sex rather than a unique personal identifier (eg, Social Security number); therefore, misspellings or incorrect birth dates could have resulted in missed matches. Only deaths occurring within Wisconsin were captured; hence, deaths among out-of-state residents and state residents who died elsewhere were missed. Patients admitted after the index visit were presumably more severely ill and were excluded, potentially introducing bias. The administrative data lacked details on social determinants of health and patterns of substance use, and the dataset had no information on stimulant-related ED visits before 2018. Data came from one state in the Midwest, and regional differences in the drug supply, including the balance of cocaine vs amphetamines and patterns of opioid contamination, may limit the applicability of the findings to other regions.

DISCLOSURES

The study received departmental funding within the Medical College of Wisconsin. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.