Association between opioid prescribing patterns and opioid overdose-related deaths.
Amy S.B. Bohnert,Marcia Valenstein,Marcia Valenstein,Matthew J. Bair,Matthew J. Bair,Dara Ganoczy,Dara Ganoczy,John F. McCarthy,John F. McCarthy,Mark A. Ilgen,Mark A. Ilgen,Frederic C. Blow,Frederic C. Blow +12 more
TLDR
Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death, and receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment.Abstract:
Context The rate of prescription opioid–related overdose death increased substantially in the United States over the past decade. Patterns of opioid prescribing may be related to risk of overdose mortality. Objective To examine the association of maximum prescribed daily opioid dose and dosing schedule (“as needed,” regularly scheduled, or both) with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders. Design Case-cohort study. Setting Veterans Health Administration (VHA), 2004 through 2008. Participants All unintentional prescription opioid overdose decedents (n = 750) and a random sample of patients (n = 154 684) among those individuals who used medical services in 2004 or 2005 and received opioid therapy for pain. Main Outcome Measure Associations of opioid regimens (dose and schedule) with death by unintentional prescription opioid overdose in subgroups defined by clinical diagnoses, adjusting for age group, sex, race, ethnicity, and comorbid conditions. Results The frequency of fatal overdose over the study period among individuals treated with opioids was estimated to be 0.04%.The risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication. The adjusted hazard ratios (HRs) associated with a maximum prescribed dose of 100 mg/d or more, compared with the dose category 1 mg/d to less than 20 mg/d, were as follows: among those with substance use disorders, adjusted HR = 4.54 (95% confidence interval [CI], 2.46-8.37; absolute risk difference approximation [ARDA] = 0.14%); among those with chronic pain, adjusted HR = 7.18 (95% CI, 4.85-10.65; ARDA = 0.25%); among those with acute pain, adjusted HR = 6.64 (95% CI, 3.31-13.31; ARDA = 0.23%); and among those with cancer, adjusted HR = 11.99 (95% CI, 4.42-32.56; ARDA = 0.45%). Receiving both as-needed and regularly scheduled doses was not associated with overdose risk after adjustment. Conclusion Among patients receiving opioid prescriptions for pain, higher opioid doses were associated with increased risk of opioid overdose death.read more
Citations
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Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
TL;DR: This guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.
Journal ArticleDOI
CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.
TL;DR: This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.
Journal ArticleDOI
The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop
Roger Chou,Judith A. Turner,Emily B Devine,Ryan N. Hansen,Sean D. Sullivan,Ian Blazina,Tracy Dana,Christina Bougatsos,Richard A. Deyo +8 more
TL;DR: In this paper, a review found that prescriptions of opioid medications for chronic pain have increased dramatically, as have opioid overdoses, abuse, and other harms and uncertainty about long-term effectiveness.
Journal ArticleDOI
Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015.
Gery P. Guy,Kun Zhang,Michele K. Bohm,Jan L. Losby,Brian Lewis,Randall Young,Louise B. Murphy,Deborah Dowell +7 more
TL;DR: Despite reductions in opioid prescribing in some parts of the country, the amount of opioids prescribed remains high relative to 1999 levels and varies substantially at the county-level, and health care providers should carefully weigh the benefits and risks when prescribing opioids.
Journal ArticleDOI
Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period
TL;DR: Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013 found male sex, age older than 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioids use among surgical patients.
References
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Journal ArticleDOI
Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
Roger Chou,Gilbert J. Fanciullo,Perry G. Fine,Jeremy A Adler,Jane C. Ballantyne,Pamela Stitzlein Davies,Marilee I. Donovan,David A. Fishbain,Kathy M. Foley,Jeffrey Fudin,Aaron M. Gilson,Alexander Kelter,Alexander Mauskop,Patrick G. O'Connor,Steven D. Passik,Gavril W. Pasternak,Russell K. Portenoy,Ben A. Rich,Richard G. Roberts,Knox H. Todd,Christine Miaskowski +20 more
TL;DR: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.
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A case-cohort design for epidemiologic cohort studies and disease prevention trials
TL;DR: A design is proposed which involves covariate data only for cases experiencing failure and for members of a randomly selected subcohort, which has relevance to epidemiologic cohort studies and disease prevention trials.
Journal ArticleDOI
Immortal Time Bias in Pharmacoepidemiology
TL;DR: Observational studies of drug benefit in which computerized databases are used must be designed and analyzed properly to avoid immortal time bias.
Journal ArticleDOI
Opioid prescriptions for chronic pain and overdose: a cohort study.
Kate M. Dunn,Kathleen Saunders,Carolyn M. Rutter,Caleb J. Banta-Green,Joseph O. Merrill,Mark D. Sullivan,Constance Weisner,Michael J. Silverberg,Cynthia I. Campbell,Bruce M. Psaty,Michael Von Korff +10 more
TL;DR: In this paper, the Cox proportional hazards models were used to estimate overdose risk as a function of average daily opioid dose (morphine equivalents) received at the time of overdose, and 51 opioid-related overdoses were identified, including 6 deaths.
Journal Article
Opioid Prescriptions for Chronic Pain and Overdose
Kate M. Dunn,Kathleen Saunders,Carolyn M. Rutter,Caleb J. Banta-Green,Joseph O. Merrill,Mark D. Sullivan,Constance Weisner,Michael J. Silverberg,Cynthia I. Campbell,Bruce M. Psaty,Michael Von Korff +10 more
TL;DR: Patients receiving higher doses of prescribed opioids are at increased risk for overdose, which underscores the need for close supervision of these patients.
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CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016
Clinical Guidelines for the Use of Chronic Opioid Therapy in Chronic Noncancer Pain
Roger Chou,Gilbert J. Fanciullo,Perry G. Fine,Jeremy A Adler,Jane C. Ballantyne,Pamela Stitzlein Davies,Marilee I. Donovan,David A. Fishbain,Kathy M. Foley,Jeffrey Fudin,Aaron M. Gilson,Alexander Kelter,Alexander Mauskop,Patrick G. O'Connor,Steven D. Passik,Gavril W. Pasternak,Russell K. Portenoy,Ben A. Rich,Richard G. Roberts,Knox H. Todd,Christine Miaskowski +20 more