Ninety-one percent of people who survived a prescription opioid overdose later obtained at least one subsequent opioid prescription, according to a Boston Medical Center study published last month in Annals of Internal Medicine.
A majority of such patients—70%—received an opioid script from the same prescriber as before the overdose.
The research team looked at a national database of insurance claims filed between 2000 and 2012, totaling 50 million people. They identified more than 2,800 patients who had been hospitalized for an opioid overdose that ultimately was nonfatal.
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The team then examined the patients' prescription history two months before the overdose and up to two years afterward.
The data did not include uninsured patients, Medicare, Medicaid, or Veterans Health Administration beneficiaries, or medications paid for with cash.
The researchers found that after the overdose:
- One-third of patients who overdosed continued to take high daily doses of opioids;
- About 10% to 15% of patients initially stopped using opioids, although most resumed within three months; and
- About 7% percent overdosed again.
Two years after the initial overdose, those who still had an opioid prescription were twice as likely to have experienced another overdose as those who no longer were prescribed the drugs.
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Potential explanations, solutions
The study authors noted that there are reasons for patients to continue with their opioid prescription after an overdose, such as if the initial dosage was too high or if a provider and patient decide that that untreated pain outweighs the risk of another overdose.
But lead study author Marc Larochelle says that in some cases, physicians likely did not know when patients overdosed, as "there is no clear mechanism to communicate events from [ED] or inpatient settings to providers in the community."
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The study suggests several ways to address the issue, such as including overdose information in prescription monitoring programs and having insurance companies alert providers after receiving a claim for overdose treatment.
However, Larochelle argues that tracking can only help so much, and that providers also need better education on when—and when not—to prescribe opioids for pain.
"Most [providers] are doing it in a very good faith effort to reduce pain, relieve suffering, and doing what's right for the patient," Larochelle says. "We need to communicate alternative options for treatment of chronic pain," Larochelle tells Reuters, "including non-opioid medications, physical therapy, and complementary and alternative treatments" (Kaplan, Los Angeles Times, 12/28/15; Doyle, Reuters, 12/29/15; Freyer, Boston Globe, 12/28/15).
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