Opioid Poisoning: Why Prescribing Guidelines Should Target Acute, Intermittent Users

As prescription opioid poisonings continue to increase, state officials move toward implementing more programs and guidelines for prescribers. These measures, however, are only effective if they’re targeting the underlying cause. 

A report published in Medical Care concluded that opioid prescribing guidelines shouldn’t only be targeting users on higher doses. According to the study, patients on higher doses are at higher risk, but that doesn’t mean acute and intermittent users on low prescribed doses should be forgotten about. 

Researchers analyzed Medicaid data on both opioid prescribing and opioid poisoning in Washington State. Between 2006 and 2010 there were 2,250 opioid overdoses occurring in 1,809 patients.

The study’s authors found that 35% of these incidents were associated with methadone. The majority of overdoses (65%) were due to other opioid medications. 

Here’s what else researchers found:

• Only 44% of patients who overdosed on opioid pain medications were chronic users.
• Only 17% of patients had a “yellow-flag” opioid dose targeted by the prescribing guideline.
• Only 28% of overdose patients had a relatively low dose.

Washington State introduced State Opioid Guidelines in 2007. These guidelines focused on high risk of overdose in chronic (long-term) users with high prescribed opioid doses.