Stimulant Toxicity Discharges Carry High One-Year Mortality
Patients discharged directly from the emergency department after receiving a diagnosis of stimulant toxicity face a one-year mortality rate of 2.1%, according to a retrospective cohort study published on October 23, 2026, in The American Journal of Emergency Medicine. This risk is approximately 14 times higher than the mortality rate observed among individuals of a similar age in the general population. Overdose accounts for roughly two-thirds of these deaths, with opioids contributing to more than half of the fatal overdoses.
Researchers analyzed records from 2,356 patients discharged directly from emergency departments between 2018 and 2023 with a primary diagnosis of stimulant toxicity. Investigators identified cases using International Classification of Diseases, Tenth Revision (ICD-10) codes covering cocaine, amphetamines, methamphetamines, methylenedioxymethamphetamine, methylphenidate, other psychostimulants, and synthetic cannabinoids. State death records provided the ICD-10 codes used to determine the causes of death within one year of the index emergency department visit.
Methamphetamines Drive Majority of Emergency Department Diagnoses
Methamphetamines and amphetamines accounted for 54% of the index diagnoses in the study group, while cocaine accounted for 24%. A total of 46 patients died within one year of their emergency department discharge, yielding the 2.1% mortality rate. The median age of decedents at the time of their index visit was 35 years, and the median time elapsed from the emergency department visit to death was 118 days.
Among the patients who died within the one-year window, 67% succumbed to an overdose. Opioids were involved in 54% of those overdose-related deaths, while stimulants were involved in 48%. Both substances were present in 37% of the overdose deaths.
Opioid Toxicity Reference Group Shows Higher Mortality
For comparison, researchers examined a reference cohort of 1,665 patients discharged after an emergency department visit for opioid toxicity. This reference group experienced a one-year mortality rate of 6.9%. The median time from the emergency department visit to death in the opioid toxicity cohort was 174 days.
Damilola Idowu, MD, of the Medical College of Wisconsin in Milwaukee, led the research team. Study authors noted that emergency department encounters for stimulant toxicity identify patients at elevated risk for subsequent mortality. Because deaths were predominantly driven by overdoses and frequently involved opioids, the authors suggested that these emergency department visits represent an important opportunity for opioid-focused harm reduction and overdose prevention.
Study Limitations and Administrative Data Constraints
The retrospective design carried several methodological limitations. Investigators identified stimulant-related visits using ICD-10 codes, which creates the potential for missed cases as well as the inclusion of visits not primarily attributable to stimulant use. Researchers matched deaths using a hashed identifier generated from patients’ names, dates of birth, and sex rather than a unique personal identifier such as a Social Security number. Consequently, misspellings or incorrect birth dates could have resulted in missed matches.
The tracking captured only deaths occurring within Wisconsin, meaning out-of-state residents and state residents who died elsewhere were missed. Patients admitted to the hospital after the index visit were presumably more severely ill and were excluded from the analysis, which may have introduced selection bias. Furthermore, the administrative data lacked details regarding social determinants of health and specific patterns of substance use, and the dataset contained no information on stimulant-related emergency department visits prior to 2018. Regional differences in the drug supply, including the balance between cocaine and amphetamines and local patterns of opioid contamination, may also limit the applicability of the findings to other geographic regions. The study received departmental funding within the Medical College of Wisconsin, and the authors reported no conflicts of interest.
Frequently Asked Questions About Stimulant Toxicity Mortality
* What caused the majority of deaths among patients discharged after stimulant toxicity?
Overdose caused approximately two-thirds of the deaths within the one-year follow-up period. Opioids contributed to more than half of these overdose-related fatalities.
* How did the mortality rate compare to patients treated for opioid toxicity?
Patients discharged after an emergency department visit for opioid toxicity experienced a higher one-year mortality rate of 6.9%, compared to 2.1% for the stimulant toxicity cohort.
* Which specific substances accounted for most of the index emergency department diagnoses?
Methamphetamines and amphetamines accounted for 54% of the index diagnoses, while cocaine accounted for 24%.
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