A Flood of Opioids, a Rising Tide of Deaths

Okie, Susan

doi:10.1056/nejmp1011512

Cited by 771 publications

(560 citation statements)

References 3 publications

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“…Despite implementation of these programs, the incidence of prescription drug overdose in the US continues to rise. [41][42][43] Poor data quality has been implicated as a barrier to the uptake of the programs. 44,45 PDMPs are statebased initiatives.…”

Section: Discussionmentioning

confidence: 99%

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

et al. 2015

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“…1,2 These trends have prompted calls for more selective opioid use, with lower doses and fewer days' supply when prescribing. 3 Clinicians often wonder how long and how high a dose of opioids can be prescribed before inadvertently promoting long-term use, yet there are few data to guide initial prescribing for opioid-naïve patients.…”

Section: Introductionmentioning

confidence: 99%

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

et al. 2016

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BACKGROUND: Long-term efficacy of opioids for noncancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use. OBJECTIVE: To examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients. DESIGN: Retrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges. PARTICIPANTS: Patients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients. MAIN MEASURES: Exposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation (Binitiation month^). Outcome: Proportion of patients with six or more opioid fills during the subsequent year (Blong-term users^). KEY RESULTS: There were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs.CONCLUSIONS: Early opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

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“…[1][2][3][4][5][6][7][8][9][10][11] Greater opioid prescribing contributed to increased opioid availability for abuse and overdose. [12][13][14] Primary care physicians (PCPs) and internists prescribe the majority of opioids.…”

Section: Introductionmentioning

confidence: 99%

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

et al. 2015

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BACKGROUND: Chronic opioid therapy for chronic pain treatment has increased. Hospital physicians, including hospitalists and medical/surgical resident physicians, care for many hospitalized patients, yet little is known about opioid prescribing at hospital discharge and future chronic opioid use. OBJECTIVE: We aimed to characterize opioid prescribing at hospital discharge among 'opioid naïve' patients. Opioid naïve patients had not filled an opioid prescription at an affiliated pharmacy 1 year preceding their hospital discharge. We also set out to quantify the risk of chronic opioid use and opioid refills 1 year post discharge among opioid naïve patients with and without opioid receipt at discharge. DESIGN: This was a retrospective cohort study. PARTICIPANTS: From 1 January 2011 to 31 December 2011, 6,689 opioid naïve patients were discharged from a safety-net hospital. MAIN MEASURE: Chronic opioid use 1 year post discharge. KEY RESULTS: Twenty-five percent of opioid naïve patients (n=1,688) had opioid receipt within 72 hours of discharge. Patients with opioid receipt were more likely to have diagnoses including neoplasm (6.3 % versus 3.5 %, p<0.001), acute pain (2.7 % versus 1.0 %, p<0.001), chronic pain at admission (12.1 % versus 3.3 %, p<0.001) or surgery during their hospitalization (65.1 % versus 18.4 %, p<0.001) compared to patients without opioid receipt. Patients with opioid receipt were less likely to have alcohol use disorders (15.7 % versus 20.7 %, p<0.001) and mental health disorders (23.9 % versus 31.4 %, p<0.001) compared to patients without opioid receipt. Chronic opioid use 1 year post discharge was more common among patients with opioid receipt (4.1 % versus 1.3 %, p<0.0001) compared to patients without opioid receipt. Opioid receipt was associated with increased odds of chronic opioid use (AOR=4.90, 95 % CI 3.22-7.45) and greater subsequent opioid refills (AOR=2.67, 95 % CI 2.29-3.13) 1 year post discharge compared to no opioid receipt. CONCLUSION:Opioid receipt at hospital discharge among opioid naïve patients increased future chronic opioid use. Physicians should inform patients of this risk prior to prescribing opioids at discharge.

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A Flood of Opioids, a Rising Tide of Deaths

Cited by 771 publications

References 3 publications

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Provider Patient-Sharing Networks and Multiple-Provider Prescribing of Benzodiazepines

Association Between Initial Opioid Prescribing Patterns and Subsequent Long-Term Use Among Opioid-Naïve Patients: A Statewide Retrospective Cohort Study

Opioid Prescribing at Hospital Discharge Contributes to Chronic Opioid Use

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