BACKGROUND:
Nonfatal
opioid overdose is an opportunity to identify and treat substance use
disorders, but treatment patterns after the overdose are unknown.
OBJECTIVE:
To
determine prescribed opioid dosage after an opioid overdose and its association
with repeated overdose.
SETTING:
A
large U.S. health insurer.
PARTICIPANTS:
2848
commercially insured patients aged 18 to 64 years who had a nonfatal opioid
overdose during long-term opioid therapy for noncancer pain between May 2000
and December 2012.
MEASUREMENTS:
Nonfatal
opioid overdose was identified using International Classification of Diseases,
Ninth Revision, Clinical Modification, codes from emergency department or
inpatient claims. The primary outcome was daily morphine-equivalent dosage
(MED) of opioids dispensed from 60 days before to up to 730 days after the
index overdose. We categorized dosages as large (≥100 mg MED), moderate (50 to
<100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes
included time to repeated overdose stratified by daily dosage as a time-varying
covariate.
RESULTS:
Over a
median follow-up of 299 days, opioids were dispensed to 91% of patients after
an overdose. Seven percent of patients (n = 212) had a repeated
opioid overdose. At 2 years, the cumulative incidence of repeated overdose was
17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after
the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages,
9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for
those receiving no opioids.
LIMITATION:
The
cohort was limited to commercially insured adults.
CONCLUSION:
Almost
all patients continue to receive prescription opioids after an overdose. Opioid
discontinuation after overdose is associated with lower risk for repeated
overdose.
From Harvard Medical School,
Harvard Pilgrim Health Care Institute, Boston University School of Medicine,
and Boston Medical Center, Boston, Massachusetts.
No comments:
Post a Comment