When patients are prescribed opioids in risky ways, their chance of dying increases and their odds of death go higher as the number of risky opioid prescriptions increase, according to a study published in the Journal of General Internal Medicine.
Studying prescription records for residents of Massachusetts over a 5-year period, researchers identified 6 types of risky opioid prescriptions and found that all were linked to a higher chance of death.
“Most people who misuse opioids are first exposed to the drugs through prescriptions so improving prescribing may be a way to reduce the risk of opioid misuse,” said Adam J. Rose, MD, Boston University School of Medicine, Boston, Massachusetts. “Our study suggests that state prescription monitoring programs may help identify inappropriate prescribing in real time.”
The study is the first to examine such a broad array of potentially inappropriate opioid prescriptions and link such prescribing to a wide array of fatal outcomes.
For the study, Dr. Rose and colleagues analysed data from 3,078,034 patients aged ≥18 years who received prescription opioids between 2011 and 2015.
The researchers looked for evidence of 6 different types of risky opioid prescribing: high-dose opioid prescriptions, prescribing of opioids along with benzodiazepines, opioids prescribed to an individual by ≥4 prescribers in a calendar year, filling opioid prescriptions at ≥4 pharmacies in a year, paying cash for an opioid prescription ≥3 times over a 3-month period, and prescribing opioids without documentation of a pain diagnosis.
The study found that lacking a documented pain diagnosis was associated with non-fatal overdose (adjusted hazard ratio [aHR] = 2.21; 95% confidence interval [CI], 2.02-2.41), as was high-dose opioids (aHR = 1.68; 95% CI, 1.59-1.76). Prescribing opioids along with benzodiazepines was associated with fatal overdose (aHR = 4.23; 95% CI, 3.85-4.65). High-dose opioids were associated with all-cause mortality (aHR = 2.18; 95% CI, 2.14-2.23), as was lacking a documented pain diagnosis (aHR = 2.05; 95% CI, 2.01-2.09).
“Our findings underscore the importance of potentially inappropriate prescribing of opioids as a contributing factor for fatal opioid overdoses and may help guide efforts to address the problem,” Dr. Rose concluded. “This could provide the basis for a system that could flag providers in real time when they are writing a potentially inappropriate prescription for opioids.”