Patients Continue to Receive Prescription Opioids Following Overdose

Research conducted at Boston Medical Center suggests that nearly all patients with chronic pain who are hospitalized after a nonfatal, prescription opioid-related overdose continue to receive this medication, despite discontinuation being associated with lower risk for repeat overdose. Published in the January 5, 2016, issue of the Annals of Internal Medicine, the study is the first to examine treatment patterns and risk of repeated overdose following a nonfatal opioid overdose, according to lead author Marc LaRochelle, MD, MPH, assistant professor of medicine at the Boston University School of Medicine and general internist at Boston Medical Center.

 

Whereas nonfatal opioid overdoses present an opportunity to identify and treat substance use disorders, prior to the study, treatment patterns following such overdoses had not been well defined. Thus, LaRochelle and colleagues set out to determine the dosages of prescribed opioids among patients who had experienced an opioid overdose, as well as the association of opioid dosage with repeated overdose.

 

The retrospective cohort study assessed the cases of 2,848 commercially insured patients aged 18 to 64 years who had been treated in the emergency department and/or as an inpatient following a nonfatal opioid overdose during long-term opioid therapy for non-cancer pain between May 2000 and December 2012.

 

The primary outcome for the study was daily morphine-equivalent dosage (MED) to opioids dispensed from 60 days before to up to 730 days after the index overdose. Dosages were categorized as large (≥100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED).

 

During a median follow-up of 299 days, 91% of patients continued to be prescribed opioids following their nonfatal overdose. Of these patients, 70% received their prescriptions from the same providers who prescribed them opioids before their initial overdoses. Repeated opioid overdoses were observed in 7% of patients.

 

At 2 years follow-up, cumulative incidence rates for repeated overdoses were 17% for patients who received high opioid dosages following their index overdose, 15% for those who received moderate dosages, 9% for those who received low dosages, and 8% for those who received no opioids. Patients who continued on high dosages of opioids were nearly twice as likely to experience a repeat overdose when compared with those whose prescription opioids were discontinued.

 

“While the nonfatal opioid overdoses in this study were treated and recorded in a patient's medical record, it is unclear if the physician who prescribed the medication was notified when their patient experienced an overdose event, which is important to note,” said LaRochelle. “This could be the result of patients not receiving emergency care where they receive outpatient care as different health systems utilize different electronic medical records—and many times, these event records never make it to the outpatient provider. As a provider, this is troublesome because this is information that I need access to in order to best treat my patient… The intent of this study is not to point fingers but rather use the results to motivate physicians, policy makers and researchers to improve how we identify and treat patients at risk of opioid-related harms before they occur.”