Study Finds 91% of Opioid Overdose Patients Who Survive Continue to be Prescribed More Opioids

Study Finds 91% of Opioid Overdose Patients Who Survive Continue to be Prescribed More Opioids

A new study reveals that most prescription opioid overdose patients who survive the overdose go right on getting more opioids prescribed to them after they recover. And that's not all. A significant number of those patients - as many as one out of every six - suffers another overdose fairly soon. And there's more. Everyone knows, or should know, that a nonfatal opioid overdose offers a perfect opportunity to identify and treat substance abuse disorders. The patient is right there, thankful to be alive and breathing again. The moment to reach out and help, the best time for an intervention, is now. But it seems that few ever receive an intervention, or any kind of counseling at all, at that most promising moment - right after that first overdose. Instead, some health care practitioners apparently continue to prescribe opioids to patients who may be dependent or addicted. And then, 17 percent of them fall victim to at least one additional overdose.

Serious research needs to ring some bells

This was a serious research project by Harvard Medical School, with substantial medical and statistical personnel from Harvard Pilgrim Health Care Institute, Boston University School of Medicine and Boston Medical Center. It was funded by grants from the Health Resources and Services Administration, Ryoichi Sasakawa Fellowship Fund and Harvard Pilgrim Health Care Institute. These are some big names. And the study was published in the preeminent Annals of Internal Medicine. It makes a lot of sense that everyone involved in pain management, as well as every physician in the country who prescribes painkillers, should pay particular attention to this study. A population of 2,848 commercially insured patients who were receiving opioids for non-cancer pain were followed from 2000 through 2012. Some 91 percent were prescribed more opioids even after experiencing an overdose within the previous 10 months or so. Overall, 7 percent of these patients had a repeated opioid overdose; and within two years, the cumulative incidence of repeated overdose was:

  • 17 percent among those receiving large doses of opioids
  • 15 percent among those receiving moderate doses
  • 9 percent among those receiving low doses
  • 8 percent among those receiving painkillers other than opioids.

A large dose was defined as 100 mg or more of morphine-equivalent dosage (MED), a moderate dose was 50 to 100 mg MED and a low dose was less than 50 mg MED.

What is morphine-equivalent dosage (MED)?

Different opioids, such as oxycodone or hydrocodone or methadone, don't provide the same amount of active opioid medication. But physicians need to calculate how much active opioid a patient is receiving (or should receive) no matter what opioid they are prescribing. They need to know how "strong" an opioid is, to avoid too much or too little. To do this, doctors use a "morphine equivalent dosage" converter which translates the strength of the most common opioids into MED units. For example:

  • 20mg of hydrocodone = 20 MED (roughly the same as morphine)
  • 20mg of oxycodone = 30 MED (a little stronger than morphine)
  • 20mg of methadone equals 60 MED (this is a powerful opioid)

Problems for pain management

According to Robert Valuk, PhD, RPh, a professor in the Department of Clinical Pharmacy, University of Denver, these results present pain management specialists with some complex problems. Valuk, who was not involved in the study, told Pain Management News that although a history of opioid overdose would seem to be a red flag, you can't just stop opioid treatment for patients who've been on the drugs for some time. Issues associated with opioid withdrawal, as well as the pain the person is in, could drive many patients to seek other drugs-including street heroin-to manage their pain. And tapering off opioids to avoid withdrawal can take anywhere from four to 12 months. Nevertheless, the overdose problems do exist, and solutions are needed. The findings of the research were yet "another example of the downstream consequences" of the increasing use of prescription opioids in this country, Valuk said.

Results were 'shocking' to researchers

"It was shocking to see that the cumulative incidence of repeated overdose reached 17 percent, or one in six for patients continued on high dosages of opioids," said Marc R. LaRochelle, MD, MPH, an assistant professor at Boston University School of Medicine and one of the study co-authors. "We need to do a better job as a health system identifying and treating patients who have experienced adverse events from prescription opioids. In order to manage risk, physicians need better information and tools to understand actual levels of risk." Here at Novus Medical Detox, our solution for ending opioid dependence may not be the answer for every pain patient's risk of overdose. But we certainly have a solution for anyone wanting to get their life back and live drug-free again.

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