Opioid Use Often Resumes After Nonfatal Overdose

The vast majority of patients with chronic pain continue to receive opioids after experiencing a nonfatal overdose, despite the fact that they face greater risk for experiencing a second overdose.

The vast majority of patients with chronic pain continue to receive opioids after experiencing a nonfatal overdose, despite the fact that they face greater risk for experiencing a second overdose.

“We were shocked that 91% of patients received one or more additional prescriptions for opioids after surviving an overdose event,” researcher Marc R. Larochelle, MD, MPH, told Pharmacy Times.

Dr. Larochelle described pharmacists as key partners in the ongoing challenge of combating opioid abuse in the health care system.

“Being at the front lines at the time of dispensing, [pharmacists] can help spot risky or concerning behaviors [such as] filling prescriptions from multiple doctors, appearing intoxicated or altered at the time of filling a prescription, or even attempts to alter prescriptions,” he said. “As a prescribing physician I would very much welcome any and all information that helps me better understand risk.

Anecdotally, pharmacists have mentioned concerns that physicians may not be receptive to pharmacist-raised concerns. I urge pharmacists to not let these responses from deterring them.”

Dr. Larochelle’s study involved 2848 commercially insured adults aged 18 to 64 years who had experienced a nonfatal opioid overdose while taking long-term opioid therapy for non-cancer pain between May 2000 and December 2012.

After a median follow-up of nearly 300 days, 91% of patients who had previously overdosed received subsequent opioid prescriptions. Of those who received an opioid prescription after an overdose, 7% overdosed again.

For patients who received high dosages of opioids, the cumulative incidence of repeated overdose was 17% at the 2-year mark. The incidence of overdose was 15% for patients who received moderate dosages, 9% for those who received low dosages, and 8% for those who did not receive additional prescriptions for opioids.

Alarmingly, 70% of the patients who received additional opioid prescriptions obtained those prescriptions from the same health care provider who prescribed them prior to their first overdose.

From these findings, the researchers concluded that discontinuing opioid use was unsurprisingly linked with a lower risk for a second overdose.

These results were published in the Annals of Internal Medicine.