Overdose and prescribed opioids: Associations among chronic non-cancer pain patients
By K. Dunn, Kathleen Saunders, Carolyn M. Rutter, Caleb J. Banta-Green, J. Merrill, Michael J. Sullivan, C. Weisner, M. Silverberg, Cynthia I. Campbell, B. Psaty and 1 more. Annals of Internal Medicine, 2010
1,282 citations recorded by the source corpus.
Background Chronic opioid therapy for chronic non-cancer pain (CNCP) is increasingly common in community practice. Concomitant with this practice change, rates of fatal opioid overdose have increased. It is not known to what extent overdose risks are elevated among patients receiving medically prescribed chronic opioid therapy. Objective To estimate rates of opioid overdose and their association with average prescribed daily opioid dose among patients receiving medically prescribed chronic opioid therapy. Design Cox proportional hazards models were used to estimate overdose risk as a function of average daily opioid dose (morphine equivalents) received at time of overdose. Setting Health maintenance organization. Patients Individuals (n=9940) who received 3+ opioid prescriptions within 90-days for CNCP between 1997 and 2005. Measurements Average daily opioid dose over the previous 90 days from automated pharmacy data. Primary outcomes, non-fatal and fatal overdoses, were identified through diagnostic codes from inpatient and outpatient care and death certificates and confirmed by medical record review. Results Fifty-one opioid-related overdoses were identified, including six deaths. Compared to patients receiving 1-20mg of opioids per day (0.2% annual overdose rate), patients receiving 50-99 mg had a 3.7 fold increase in overdose risk (95% C.I. 1.5, 9.5) and a 0.7% annual overdose rate. Patients receiving 100mg or more per day had an 8.9 fold increase in overdose risk (95% C.I. 4.0, 19.7) and a 1.8% annual overdose rate. Limitations Increased overdose risk among patients on higher dose regimens may be due to confounding by patient differences and by use of opioids in ways not intended by prescribing physicians. The small number of overdoses in the study cohort is also a limitation. Conclusions Patients receiving higher doses of prescribed opioids are at increased risk of opioid overdose, underscoring the need for close supervision of these patients.
Subfields: Anesthesiology and Pain Medicine, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health
View Paper: https://www.semanticscholar.org/paper/e967f6bff94bf4d252669b02f601a16a9d27c539
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Citations in the corpus
- CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016 (2016, background): “In case-control and case-cohort studies, substance abuse/dependence was more prevalent among patients experiencing overdose than among patients not experiencing overdose (12% versus 6% [66], 40% versus 10% [24], and 26% versus 9% [23]).”
- CDC guideline for prescribing opioids for chronic pain (2016, background): “9 (102) for dosages of at least 100 MME/day.”
- 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 (2015, background): “Appendix Table 2—Continued Study, Year (Reference) Design; Country Quality Eligibility Criteria Comparison Groups Overdose Dunn et al, 2010 (42) Retrospective cohort; United States Fair Patients aged >18 y starting new episode of opioid use (no opioids in past 6 mo); ≥3 opioid prescriptions filled i”
- CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016. (2016, positive): “In case-control and case-cohort studies, substance abuse/dependence was more prevalent among patients experiencing overdose than among patients not experiencing overdose (12% versus 6% [115], 40% versus 10% [20], and 26% versus 9% [19]).”
- A comprehensive review of opioid-induced hyperalgesia. (2011, background): “Among those problems are a lack of evidence supporting their long-term effectiveness, misuse and abuse of prescription opioids, and multiple adverse events associated with long-term opioid use, including opioidinduced hyperalgesia (OIH) (1-17).”