Current guidelines for appropriate prescribing of opioid pain medications often focus on chronic users of these drugs, but these recommendations may be missing patients with acute and intermittent use of low-dose opioids who are also at a risk of opioid overdose.
In a study appearing in Medical Care, Deborah Fulton-Kehoe, PhD, from the University of Washington School of Public Health in Seattle, WA, and colleagues conducted a retrospective cohort study using Medicaid data on opioid prescribing and opioid poisoning in Washington from April 2006 to December 2010. The authors sought to assess changes to opioid prescriptions and overdoses following the Washington State Interagency Guideline on Opioid Dosing for Chronic Non-Cancer Pain in 2007, designed to provide specific dosing guidance, including a recommendation that providers seek pain management consultation before exceeding a dose of 120mg/day morphine-equivalent dose (MED), best practices, opioid-dosing calculator, and web-based continuing medical education. Patients between the ages of 18–64 with at least one claim for an opioid prescription for non-cancer pain in the Medicaid fee-for-service system and had an emergency department or inpatient hospital claim for an opioid poisoning were included and it was noted if there were sedatives (eg, barbiturates, muscle relaxants, sedatives, hypnotics, and anti-anxiety medications) were available in the 30 days prior to opioid poisoning.
Overall 2,250 opioid overdoses in 1,809 patients were identified, with 35% from methadone use and 65% from other opioid medications. For those who had overdosed on methadone, in the year prior to overdose only 38% had a paid prescription for methadone, 35% no prescriptions for methadone but did for other opioids, and 26% had no opioid prescriptions. Only 44% of those who overdosed on opioid medications were chronic users and in the week prior to poisoning, only 17% had a MED of >120mg/day, 28% had doses <50mg/day MED, and 48% had concurrent sedative prescriptions.
The authors stated that because only a small fraction of patients in this study were taking MED-doses of >120mg/day, opioid guidelines and other education interventions need to address opioid overdoses occurring among other patients and the use of concurrent sedative prescriptions.
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