Investigators identify factors associated with post-prescription opioid overdose

As the opioid epidemic continues to be a public health crisis in the United States, researchers sought to assess patient and prescribing factors associated with opioid-related overdose.

Scott Weiner, MD, MPH, Department of Emergency Medicine, Brigham and Women’s Hospital, led a team of researchers in conducting a cohort study that evaluated opioid-naïve adult patients.

The primary outcome was an overdose event with follow-up to identify death from opioid overdose. Major risk factors included being 75 or older, being male, having Medicaid or Medicare Advantage coverage, having a comorbid substance use disorder or depression, and to have medical comorbidities.

Examination of the problem

“Each prescription of an opioid to a previously opioid-naïve patient creates the potential for the development of chronic opioid use and opioid use disorder,” the investigators wrote.

Although the use of opioid medications has declined, the United States still had 168.9 million opioid prescriptions in 2018. Previous literature has reported that the initial amount of prescription or duration of use is associated with the development of long-term use.

The dispensing patterns of patients with long-term use are described by prescription drug monitoring programs. However, these programs do not collect data on medication indications, comorbid conditions, patient environment, or intermediate outcomes, such as opioid use disorders or overdoses.

Investigators addressed data source limitations by combining claims data with multiple public health datasets to create the Oregon Comprehensive Opioid Risk Registry, a comprehensive post-onset risk factor analysis. of opioid treatment.

Full analysis

The comprehensive Oregon Opioid Risk Registry that investigators created links all payer claims data to other health data sets in the state of Oregon.

In this cohort study, the patient population-based observational sample first filled an opioid prescription in 2015, with follow-up through the end of 2018.

During the follow-up period, investigators identified fatal or non-fatal opioid overdoses as the primary outcome. Data was analyzed from March 2020 to June 2021.

Identification of patient and prescription factors

The highest risk of overdose among the 236,921 patients in the cohort was aged 75 or older, compared to those aged 35 to 44.

The following risks were also significant: being male; those who were eligible for both Medicaid and Medicare Advantage; had Medicaid or had Medicare Advantage compared to those with commercial insurance; those with a comorbid substance use disorder; those with depression; those with comorbidities versus those without.

Additionally, an increased risk was observed in patients on oxycodone or tamadol compared to codeine; benzodiazepines used; simultaneously used opioids and benzodiazepines; or filled opioid prescriptions from 3 or more pharmacies within 6 months.

“These findings may guide opioid counseling and monitoring, the development of clinical decision-making tools, and opioid prevention and treatment resources for those most at risk of opioid overdose,” the authors wrote. investigators.

The study, “Factors Associated With Opioid Overdose After an Initial Opioid Prescription” was published in Open JAMA Network.

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