Most Physicians Still Prescribe Opioids After an Overdose

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To prescribe or not to prescribe? That is the question. When it comes to patients who have overdosed on opioids, the majority get another prescription for the medication.

In a study published in the Annals of Internal Medicine, the Boston-based authors looked at 2848 commercially insured patients who had received long-term opioid therapy for non-cancer pain. The patients, ages 18 to 64, all had a nonfatal opioid overdose between May 2000 and December 2012.

During the median 299-day follow-up, 91% of patients received another prescription for opioids following the overdose. But which patients were most likely to overdose again? The data reviewed morphine-equivalent dosage (MED) of opioids following the initial incidents.

“Ninety-one percent got another prescription for an opioid. It wasn’t because they went down the street and found a new doctor. Seventy percent got it from the doctor who had prescribed before the overdose,” lead researcher Marc Larochelle, MD, MPH, told the Boston Globe.

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What may be even more interesting than that staggering statistic is that only 212 patients (7%) had a repeated opioid overdose during the median follow-up period. After two years, repeated overdose occurred in 17% of high dosage patients (>100 mg MED), 15% in moderate dosage patients (50 to <100 mg MED), and 9% in low dosage patients (<50 mg MED). Therefore, the findings suggest that prescribing a patient with a previous opioid overdose does not necessarily mean that they will have a repeated occurrence. In fact, an overwhelming majority of the time it will not — as found in this research anyway.

The question here may simply be — why? Why are physicians continuing to break out their prescription pads for patients who overdosed not even a year earlier? After all, it’s no secret that the opioid epidemic is getting worse and combatting it continues to be a challenge.

Notably, 8% of patients in this study who were not receiving opioids had a repeated overdose. This indicates several points: for one, it means that discontinuing the prescription leads to less repeated overdoses; and two, since there were still repeated overdoses, it suggests the patients went elsewhere to obtain the medication other than the original prescribing physician.

This opioid epidemic needs a 180, and while it’s not going to happen overnight, identifying contributing factors can help lead to the positive flip.