The Critical Window After an Overdose
A nonfatal opioid overdose is often treated as a near miss. But clinically, it is one of the strongest predictors of future harm — and one of the few moments when patients are actively engaged with the health care system. What happens next can shape outcomes long after the crisis has passed.
At Yale School of Medicine (YSM), Maryam Kazemitabar, PhD, associate research scientist (general medicine), studies how health systems respond in this critical window. In a recent paper published in the Journal of Addiction Medicine, she examined care in the 90 days following a nonfatal opioid overdose.
We spoke with her about what her research reveals about post-overdose care, why this moment is often missed, and how more intentional follow-up could save lives.
Your work sits at the intersection of data science, pain management, and addiction medicine. How did you carve out this focus at YSM — and what does YSM uniquely allow you to do that other places might not?
I came to Yale with a strong interest in using real-world health data to answer meaningful clinical questions. My background is in psychometrics, which focuses on the theory and techniques of measurement and on quantifying mental and health-related outcomes. I’ve always been drawn to research that can directly inform patient care. Working within YSM has been especially impactful because research, clinical practice, and focus on patient-centered outcomes such as pain are so closely connected. Over time, that environment led me to focus on pain management — both pharmacological and non-pharmacological — and on generating evidence that can support more patient-centered care.
Your recent study focuses on what happens after a nonfatal opioid overdose — a moment most people rarely think about. Why is that moment so revealing?
A nonfatal overdose is a major warning sign. It tells us that someone is at very high risk of future harm or death. At the same time, it’s one of the moments when patients are most likely to be in contact with the health care system. That combination makes it incredibly important. We wanted to understand what kinds of follow-up care patients actually receive after surviving an overdose and whether those responses align with what we know saves lives.
What you found is striking: Most patients received opioid dose reductions, while fewer than 10 percent were started on medications that treat opioid use disorder. What does that gap tell us about how the system responds to risk?
It suggests that many clinicians are responding through a risk-management lens — by reducing or stopping opioid prescriptions — which can be an important safety step. But dose reduction alone does not treat opioid use disorders. In some cases, abrupt or poorly managed tapers can actually increase risk. The relatively low use of medications for opioid use disorder highlights that more work is needed around training, care coordination, and integrating evidence-based treatments into routine post-overdose care.
You frame nonfatal overdose as both a warning sign and an opportunity. What’s being missed in that window, and what could change if we treated it differently?
If we intervene effectively with addiction treatment consultation, appropriate medications, and follow-up support, we have the chance to change someone’s trajectory. Understanding how care is currently delivered during this period helps us identify where those opportunities are being missed and how they can be strengthened.
General Internal Medicine, one of 10 sections in the Yale Department of Internal Medicine, is committed to the core missions of patient care, research, education, and community health from the “generalist” perspective. To learn more, visit General Internal Medicine.
(Newswise/HG)
