News Release
Risky Prescribing of Opioids Linked to More Fatal Overdoses and Other Deaths
Jun 18, 2018
Potentially Inappropriate Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011-2015
Published in: Journal of General Internal Medicine (2018). doi:10.1007/s11606-018-4532-5
Posted on RAND.org on August 23, 2018
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Access further information on this document at Springer USThis article was published outside of RAND. The full text of the article can be found at the link above.
Background
Potentially inappropriate prescribing (PIP) may contribute to opioid overdose.
Objective
To examine the association between PIP and adverse events.
Design
Cohort study.
Participants
Three million seventy-eight thousand thirty-four individuals age ≥ 18, without disseminated cancer, who received prescription opioids between 2011 and 2015.
Main Measures
We defined PIP as (a) morphine equivalent dose ≥ 100 mg/day in ≥ 3 months; (b) overlapping opioid and benzodiazepine prescriptions in ≥ 3 months; (c) ≥ 4 opioid prescribers in any quarter; (d) ≥ 4 opioid-dispensing pharmacies in any quarter; (e) cash purchase of prescription opioids on ≥ 3 occasions; and (f) receipt of opioids in 3 consecutive months without a documented pain diagnosis. We used Cox proportional hazards models to identify PIP practices associated with non-fatal opioid overdose, fatal opioid overdose, and all-cause mortality, controlling for covariates.
Key Results
All six types of PIP were associated with higher adjusted hazard for all-cause mortality, four of six with non-fatal overdose, and five of six with fatal overdose. Lacking a documented pain diagnosis was associated with non-fatal overdose (adjusted hazard ratio [AHR] 2.21, 95% confidence interval [CI] 2.02-2.41), as was high-dose opioids (AHR 1.68, 95% CI 1.59-1.76). Co-prescription of benzodiazepines was associated with fatal overdose (AHR 4.23, 95% CI 3.85-4.65). High-dose opioids were associated with all-cause mortality (AHR 2.18, 95% CI 2.14-2.23), as was lacking a documented pain diagnosis (AHR 2.05, 95% CI 2.01-2.09). Compared to those who received opioids without PIP, the hazard for fatal opioid overdose with one, two, three, and [greater than or equal to] four PIP subtypes were 4.24, 7.05, 10.28, and 12.99 (test of linear trend, p < 0.001).
Conclusions
PIP was associated with higher hazard for all-cause mortality, fatal overdose, and non-fatal overdose. Our study implies the possibility of creating a risk score incorporating multiple PIP subtypes, which could be displayed to prescribers in real time.
Access further information on this document at Springer US
This article was published outside of RAND. The full text of the article can be found at the link above.
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