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Study: Opioid Prescriptions Continue After Overdose

Findings reflect fragmented health system, author says

Almost all people who overdose on prescription opioids continue to receive prescriptions for these painkillers, according to a study led by researchers at Harvard Medical School.

The authors conducted a retrospective cohort analysis to determine the prescribed opioid dosage after an opioid overdose and its association with repeated overdose. The study included 2,848 commercially insured adults (18 to 64 years of age) who had experienced a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012.

Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes from emergency department or inpatient claims. The study’s primary endpoint was the daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. The authors categorized dosages as large (greater than or equal to 100 mg MED), moderate (50 to less than 100 mg MED), low (less than 50 mg MED), or none (0 mg MED).

Over a median follow-up period of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At two years, the cumulative incidence of repeated overdose was 17% for patients receiving high dosages of opioids after the index overdose; 15% for those receiving moderate dosages; 9% for those receiving low dosages; and 8% for those receiving no opioids.

“We found the results both surprising and concerning,” lead author Dr. Marc R. Larochelle told Reuters Health. “While this study wasn’t designed to answer why, one possibility is that providers are not aware that their patients experienced an overdose when making the decision to continue prescribing opioids. This lack of knowledge may be a symptom of our fragmented health care system where there is no clear mechanism to communicate events from emergency department or inpatient settings to providers in the community.”

Dr. Jessica Gregg of Central City Concern in Portland, Oregon, wrote an editorial accompanying the new results.

“There are no widespread systems in place, either within health plans or through governmental organizations, for notifying providers when overdoses occur,” she told Reuters Health.

Overdoses often happen when patients take too much of an opioid or when they take them in conjunction with other medications, like benzodiazepines, or with alcohol, Gregg said.

“Patients who have misused their prescriptions are unlikely to report that misuse (and their subsequent overdose) to their prescriber out of concern that the provider will terminate their prescriptions,” Gregg said.

In addition, most physicians receive little training and have few resources to address chronic pain, so opioids are one of few options, she said.

Sources: Annals of Internal Medicine; December 29, 2015; and Reuters Health; December 29, 2015.

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