Most patients who experience a nonfatal prescription opioid overdose continue to receive opioids afterward, increasing their risk for a second overdose, finds a retrospective study in the Annals of Internal Medicine.
Using data from a U.S. health insurer, researchers studied some 2800 adults who survived a first opioid overdose during long-term opioid therapy for noncancer pain. Over roughly 10 months post-overdose, 91% of patients continued to receive opioid prescriptions; for 61% of these patients, the same clinician issued prescriptions both pre- and post-overdose.
At 2 years, the incidence of repeated overdose was significantly higher among those prescribed high- and moderate-dosage opioids after the first overdose (roughly 16%) than among those who discontinued opioids (8%).
Calling the findings “astonishing,” an editorialist notes that many prescribers likely did not know about the index overdoses. She calls for system-wide changes to enhance communication across providers, improve clinician training in opioid tapering and buprenorphine use, and improve resident education in pain and addiction treatment.