Risk Factors of Prescription Opioid Overdose among Colorado Medicaid Beneficiaries

Highlights

• This article presents the risk factors of opioid overdose among the Colorado Medicaid population.
• Six factors were associated with opioid overdose including mean morphine dose equivalent (>50 mg/day), methadone use, drug/alcohol abuse, psychiatric illness, benzodiazepine use, and the number of different pharmacies used by the beneficiary.
• States and communities should ensure the availability of at-home intra-nasal naloxone for overdose rescue based on the presence of risk factors.

This study aims to determine risk factors of opioid overdose among the Colorado Medicaid population. A retrospective nested case-control study was undertaken. Medicaid beneficiaries who had a medical claim(s) for an emergency department visit or a hospitalization associated with an opioid overdose from July 2009 to June 2014 were defined as cases. Controls were selected using a nearest neighbor matching without replacement. The matched controls were selected based on age, gender, and opioid prescription. One case was matched with three controls. Multivariate conditional logistic regression was used to compare risk factors. 

A total of 816 cases with 2,448 controls were included. Six factors were associated with opioid overdose: mean morphine dose equivalent (>50 mg/day), methadone use (switching opioid to methadone vs. no methadone use), drug/alcohol abuse, other psychiatric illness, benzodiazepine use, and the number of pharmacies utilized by the beneficiary (≥4 pharmacies vs. 1 pharmacy). 

In conclusion, several factors are associated with opioid overdose. States and communities should ensure the availability of at-home intra-nasal naloxone for overdose rescue based on the presence of risk factors.

PERSPECTIVES:

This article presents the risk factors of opioid overdose among Colorado Medicaid population. Based on study findings, Colorado Medicaid is currently working with physicians, hospitals, and other health-system stakeholders to continue develop policies to identify and assist this subset of our population. One such policy will be to provide intranasal naloxone for overdose rescue.

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By:   Dilokthornsakul P1, Moore G2, Campbell JD2, Lodge R3, Traugott C3, Zerzan J3, Allen R4, Page RL 2nd2.

• 1Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences (http://www.ucdenver.edu/academics/colleges/pharmacy/Pages/SchoolofPharmacy.aspx), University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand. Electronic address: piyamethd@gmail.com.
• 2Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
• 3Department of Health Care Policy and Financing, State of Colorado.
• 4Peak Statistical Services, Evergreen, CO, USA.
• J Pain. 2015 Dec 22. pii: S1526-5900(15)00985-2. doi: 10.1016/j.jpain.2015.12.006.
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