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Most US patients continue to be prescribed opioids after overdose

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.h7010 (Published 04 January 2016) Cite this as: BMJ 2016;352:h7010
  1. Jacqui Wise
  1. 1London

More than 90% of US patients who survive an overdose of prescribed opioids continue to be prescribed opioids, usually by the same prescriber, shows a retrospective cohort study published in Annals of Internal Medicine.1

The researchers used a commercial insurance database with data on 50 million people to identify 2848 patients who had a non-fatal overdose while taking opioids prescribed for chronic pain between 2000 and 2012. Over a median follow-up period of 299 days, opioids were dispensed to 91% of patients after an overdose. During this time 212 patients (7%) had a repeated opioid overdose. In addition, most (70%) of the patients received prescriptions from the same provider who prescribed them opioids before their initial overdose.

Higher dosages were associated with an increased risk of repeated overdose. At two years, the cumulative incidence of repeated overdose was 17% among patients who were prescribed high doses of opioids (≥100 mg morphine equivalent a day). This compared with 9% among those who were prescribed low dosages (<50 mg morphine equivalent a day) and 8% among those receiving no opioids.

The study also found that the mean daily dose in the group increased rapidly the week before overdose. This indicates that these patients had an increase in pain, an acute increase in drug seeking behaviour, or both immediately before their overdose.

Prescribing guidelines are clear that prescribed opioids should be withdrawn after an adverse event such as an overdose. However, the researchers said that their findings don’t necessarily reflect poor prescribing practices. They pointed out that many of the prescribers may not have known about their patients’ overdoses, as no widespread systems are in place for notifying providers when overdoses occur.

The researchers concluded, “Our finding that almost all patients continue to be prescribed opioids after overdose is highly concerning. The overdoses we detected were captured in routine claims data and treated in emergency departments or inpatient settings and thus represent identifiable events when information sharing might lead to improved care and outcomes.”

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Cite this as: BMJ 2016;352:h7010

References

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