Large Language Models for Drug Overdose Prediction from Longitudinal Medical Records

-- The ability to predict drug overdose risk from a patient's medical records is crucial for timely intervention and prevention. Traditional machine learning models have shown promise in analyzing longitudinal medical records for this task. However, recent advancements in large language models (LLMs) offer an opportunity to enhance prediction performance by leveraging their ability to process long textual data and their inherent prior knowledge across diverse tasks. In this study, we assess the effectiveness of Open AI's GPT -4o LLM in predicting drug overdose events using patients' longitudinal insurance claims records. We evaluate its performance in both fine-tuned and zero-shot settings, comparing them to strong traditional machine learning methods as baselines. Our results show that LLMs not only outperform traditional models in certain settings but can also predict overdose risk in a zero-shot setting without task-specific training. Drug overdose (OD) is a major public health crisis in the United States, leading to a substantial number of emergency medical interventions and fatalities each year. According to the Centers for Disease Control and Prevention (CDC), drug overdoses claimed approximately 107,941 [1] lives in the U.S. in 2022, highlighting the urgent need for effective prevention and intervention strategies. Besides fatal outcomes and lost quality of life for patients, the misuse of prescription medications, illicit drugs, and polysubstance abuse has placed an immense burden on healthcare systems, emergency responders, and policymakers. Identifying individuals at risk early can facilitate timely interventions, such as targeted clinical assessments, behavioral support, and prescription monitoring, thereby reducing the likelihood of fatal outcomes. Md Sultan Al Nahian is with the Institute for Biomedical Informatics, University of Kentucky, Lexington, KY 40536 USA. Chris Delcher and Daniel Harris are with the Department of Pharmacy Practice and Science, University of Kentucky, Lexington, KY 40536 USA. Peter Akpunonu is with the Department of Emergency Medicine, University of Kentucky, Lexington, KY 40536 USA.