Patients discharged from hospitals against medical advice may face significantly higher risks of overdose and death, according to new research published in the Canadian Medical Association Journal. The study highlights the potential of risk prediction tools to identify individuals most vulnerable to these outcomes following a “before medically advised” (BMA) discharge.
Every year, approximately 500,000 people in the United States and 30,000 individuals in Canada leave hospitals despite physician recommendations. The research indicates that these patients are about twice as likely to die and nearly ten times more likely to experience an illicit drug overdose within the first 30 days after discharge.
Dr. Hiten Naik from the University of British Columbia and his co-authors suggest that calculating a specific patient’s risk of death and drug overdose—alongside clinical judgment—can facilitate informed, patient-centered discussions regarding the decision to proceed with a BMA discharge. This approach could help assess a patient’s capacity to make such decisions and explore strategies to mitigate risks post-discharge.
Understanding the Risk Factors
The researchers developed two risk prediction models aimed at estimating mortality and overdose risks. The first model assesses the risk of death from any cause within 30 days following a BMA discharge, while the second focuses specifically on patients with substance use histories to evaluate the risk of illicit drug overdose.
Data from British Columbia was utilized to analyze two cohorts: cohort A consisted of 6,440 adults from the general population, and cohort B included 4,466 individuals with a history of substance use. Findings revealed that in cohort A, death occurred less frequently than anticipated, with only one death for every 63 BMA discharges. Key predictors of mortality included multimorbidity, heart disease, and cancer.
In contrast, cohort B displayed alarming trends. Factors such as homelessness, reliance on income assistance, and previous drug overdoses significantly increased the likelihood of experiencing a drug overdose after BMA discharge. The authors reported that among patients with substance use histories, approximately one illicit drug overdose occurred for every 19 BMA discharges. This underscores a critical, yet often overlooked, window for overdose prevention.
Implementing Predictive Models for Better Outcomes
The study advocates for integrating risk prediction models into hospital systems to enhance the management of high-risk BMA discharges. By automating alerts and enrolling patients in support programs, healthcare providers could better address the needs of vulnerable populations.
“These models offer a starting point for identifying patients who are at high risk and may benefit from greater support,” the authors concluded. The findings indicate that by utilizing these predictive tools, healthcare professionals can reduce uncertainty and potentially alleviate moral distress associated with BMA discharges.
Further information on this research can be found in the article titled “Predicting drug overdose and death after ‘before medically advised’ hospital discharge,” published in the Canadian Medical Association Journal in 2025. The DOI for the study is 10.1503/cmaj.250492.
