Most patients with chronic pain who are hospitalized following a nonfatal opioid overdose continue to receive prescription opioids after the overdose and are at high risk for experiencing another overdose, according to a study published in the Annals of Internal Medicine.

This is the first study to look at treatment patterns and risk of repeated overdose after a nonfatal opioid overdose, explained Marc LaRochelle, MD, MPH, leader of the study team.

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Researchers from Boston University Medical Center identified about 3,000 patients who were prescribed opioids for chronic pain that were treated in the emergency department and/or as an inpatient after a nonfatal opioid overdose through the Optum claims database. 

Following the nonfatal overdose, 91% of patients continued to be prescribed opioids. Also, 70% received prescriptions from the same clinician who prescribed the opioids prior to their initial overdose. At 2 years follow-up, the team found that patients who continued to take high-dose opioids were twice as likely to experience another overdose versus those who discontinued use after the initial overdose.

Dr. LaRochelle noted that it is unclear if the prescriber was informed when their patient experienced an overdose as medical records just show that the overdoses were treated. The lack of notification may be due to patients not getting emergency care where they receive outpatient care as different health systems use different electronic medical records. 

Some ways to improve notification of the treated nonfatal overdoses would be to have a “seamless communication stream” between emergency and/or hospital providers and outpatient providers. Prescription drug monitoring programs could be utilized to improve communication. Also, prior authorizations could be put in place for patients following an overdose before they can fill another opioid prescription.

Study findings emphasize the challenges that physicians face in balancing the risks and benefits of prescription opioids for patients with chronic pain. It highlights the importance of developing tools that will help better identify and treat patients at risk for opioid use disorders and/or overdose.

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