29 Dec Most Patients Receive Another Opioid Prescription After Overdose
MedicalResearch.com Interview with:
Marc R. Larochelle, MD, MPH
Assistant Professor of Medicine
Boston Medical Center
Medical Research: What is the background for this study? What are the main findings?
Dr. Larochelle: More than 16 thousand people in the United States die from prescription opioid overdose each year. However, morbidity extends well beyond fatal overdose – nearly half a million emergency department visits each year are related to prescription opioid-related harms. Emergency department visits for misuse of opioids represent an opportunity to identify and intervene on opioid use disorders, particularly for patients who receive prescriptions for opioids to treat pain. We examined a cohort of nearly 3000 commercially insured individuals prescribed opioids for chronic pain who were treated for a nonfatal opioid overdose in an emergency department or inpatient setting. We were interested in examining rates of continued prescribing after the overdose and the association of that prescribing with risk of repeated overdose. We found that 91% of individuals received another prescription for opioids after the overdose. Those continuing to receive opioids at high dosages were twice as likely as those whose opioids were discontinued to experience repeated overdose.
Medical Research: What should clinicians and patients take away from your report?
Dr. Larochelle: As a health system, we need to do better in responding to data that suggest patient’s have an opioid use disorder. We do not know if providers in this study were made aware of the nonfatal opioid overdoses their patients had experienced. Policy makers can facilitate development of systems to improve communication of risky events such as nonfatal overdose. Leveraging the infrastructure of prescription monitoring programs that exist in 49 states is one potential avenue for this communication. Clinicians need to be vigilant in their monitoring of patients prescribed opioids and equip themselves with the tools to effectively respond to evidence of misuse. This response needs to include training of more providers trained in treating opioid use disorders.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Larochelle: We need to understand the degree to which providers are aware of nonfatal opioid overdose events when they occur. We also need better tools to help providers identify whether or not patients prescribed opioids for chronic pain are at high risk for or are actively experiencing opioid-related harms.
Larochelle MR, Liebschutz JM, Zhang F, Ross-Degnan D, Wharam JF. Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study. Ann Intern Med. [Epub ahead of print 29 December 2015] doi:10.7326/M15-0038
Marc R. Larochelle, MD, MPH (2015). Most Patients Receive Another Opioid Prescription After Overdose