Majority of Patients Continue to Receive Opioids After Overdose

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More than 90% of patients with chronic pain continue to receive prescription painkillers even after an overdose.
More than 90% of patients with chronic pain continue to receive prescription painkillers even after an overdose.

More than 90% of patients with chronic pain continue to receive prescription painkillers after an overdose, according to a study published in Annals of Internal Medicine.

The report's findings also revealed that 70% of those individuals were prescribed additional opioids by the same clinician who had treated them with pain medications before their initial overdose.

Researchers from Boston Medical Center (BMC) analyzed data from Optum, a national commercial insurance claims database, for their research. The team examined nearly 3,000 individuals from the available data set, which included patients who had experienced a nonfatal overdose while taking opioids prescribed for chronic pain.

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Researchers from Boston Medical Center (BMC) analyzed data from Optum, a national commercial insurance claims database, for their research. The team examined nearly 3,000 individuals from the available data set, which included patients who had experienced a nonfatal overdose while taking opioids prescribed for chronic pain.

Study author Marc LaRochelle, MD, MPH, a physician in general internal medicine at BMC, told Clinical Pain Advisor that he is not sure if clinicians are aware of when a patient overdoses.

At 2 years of follow-up, patients who continued taking high dosages of opioids were twice as likely to have another overdose compared to those who discontinued opioid use after their initial overdose, the researchers found.

"If clinicians are aware, more research is needed to understand why they continue to prescribe," he said.

The study authors note several ways to improve notifying prescribers of opioid-related overdoses. One suggestion is to enhance prescription drug monitoring programs (PDMPs) by strengthening communication between clinicians and emergency providers. Another recommendation is to implement a prior authorization policy for patients who overdose on opioids by connecting health insurance records and health care providers. 

"The vast majority of clinicians are practicing in good faith to improve their patients' health and well-being," Dr LaRochelle said. "While efforts to identify and deal with outlier prescribers such as those running ‘pill mills' are important, we really need to give providers improved tools to identify and respond to instances when patients prescribed opioids for pain are experiencing more harm than benefit from the medicine."

Reference

Larochelle M, Liebschutz J, Zhang F, Ross-Degnan D, Wharam J. Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study. ‎Ann Intern Med 2015. doi:10.7326/M15-0038.

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