Greater Number of Opioid Prescribers Associated With Higher Overdose Risk

Among the patterns that may increase the risk for opioid overdose, receiving opioids from >1 vs 1 prescriber/pharmacy is predominant, according to an observational study published in the Annals of Internal Medicine.

Investigators obtained prescription drug and medical claims for a random 5% sample of Medicare beneficiaries without a cancer diagnosis who had received an opioid prescription (ie, any drug containing an opioid analgesic) between 2008 and 2012. Drug quantity, overlapping prescriptions, multiple prescribers or pharmacies, and the use of out-of-state prescribers or pharmacies were evaluated. Opioid overdose was the primary outcome.

Of the enrolled Medicare beneficiaries assessed, 0.6% to 8.5% were found to exhibit opioid misuse. Patients obtaining opioid medications from 2, 3, or 4 prescribers during a 6-month period were found to be more likely to experience an opioid overdose in the next year (adjusted absolute risk per 1000 beneficiary-years [aAR]: 2 prescribers, 3.5; 95% CI, 3.3-3.7; 3 prescribers, 4.8; 95% CI, 4.5-5.2; 4 prescribers, 6.4; 95% CI, 5.8-6.9) compared with patients who had only 1 opioid prescriber (aAR, 1.9; 95% CI, 1.8-2.0).

Patients with a >210-day supply of opioids over a 180-day period were found to have a high risk for opioid overdose in the next year (aAR, 8.5; 95% CI, 7.9-9.1), 30-day mortality following an overdose (aAR, 0.3; 95% CI, 0.19-0.43), and overall mortality (aAR, 63.0; 95% CI, 61.2-64.8). In addition, obtaining opioid medications from ≥5 pharmacies was associated with increased risk for opioid overdose (aAR, 12.9; 95% CI, 11.3-14.5) or 30-day mortality following an overdose (aAR, 0.5; 95% CI, 0.1-0.8).

A limitation of this analysis includes its potential difficulty to generalize to non-Medicare beneficiaries.

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”Our findings also have implications for optimizing the design of [prescription drug monitoring programs (PDMPs)] interfaces to help prescribers interpret PDMP records. For example, PDMPs might design patient ‘dashboards’ that sum the number of days supplied and number of prescribers or pharmacies for easy interpretation by clinicians, which ideally could be integrated directly into an electronic health record,” concluded the study authors.

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Carey CM, Jena AB, Barnett ML. Patterns of potential opioid misuse and subsequent adverse outcomes in medicare, 2008 to 2012 [published online May 22, 2018]. Ann Intern Med. doi:10.7326/M17-3065