Opioid Overdose: Risk Assessment and Mitigation in Outpatient Treatment

Lin, Lewei Allison; Hosanagar, Avinash; Park, Tae Woo; Bohnert, Amy S. B.

doi:10.1097/adm.0000000000000241

Cited by 2 publications

(1 citation statement)

References 17 publications

(16 reference statements)

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“…Our analysis controls for many known overdose risk factors, such as history of overdose or SUDs and high dose opioid prescriptions [ 38 ], but it is possible that additional considerations known to affect overdose risk are revealed in clinical interactions. These may include social factors such as homelessness [ 39 ] and physical signs of injection drug use [ 40 ]. Although the Institute of Medicine has called for improved documentation of social and behavioral factors like housing insecurity in EHR systems [ 41 ], the recommendations are not included in the EHR for available Health Facts data years.…”

Section: Discussionmentioning

confidence: 99%

Associations between naloxone prescribing and opioid overdose among patients with acute and chronic pain conditions

Qeadan

Madden

2021

Addiction

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AimsTo assess whether naloxone prescribing in clinical contexts targeted pain patients most at risk for opioid overdose. Design A retrospective cohort study using data from the Health Facts Database. Setting Over 600 United States healthcare facilities. Participants Three patient groups were followed for 2 years during 2009 to 2017: individuals with shoulder or long bone fractures (n = 252 424), chronic pain syndrome (CPS) (n = 76 141), or non-traumatic low back pain (n = 792 956) who received an opioid prescription. Groups were chosen based on previous work. MeasurementsThe outcome was opioid overdose identified by International Classification of Diseases codes (ICDs) and the primary predictor was number of naloxone prescriptions identified by National Drug Codes (NDCs).Findings Opioid overdoses occurred among 0.16% of fracture patients (average follow-up time to overdose[AFU] = 240 days), 1.28% of CPS patients (AFU = 244 days), and 0.30% low back pain patients (AFU = 264 days). A total of 58 083 bone fracture patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (hazard ratio [HR] = 1.87, 95% CI = 1.68-2.09), and number of subsequent overdoses (incidence rate ratio [IRR] = 1.89, 95% CI = 1.69-2.12). A total of 19 529 CPS patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (HR = 1.69, 95% CI = 1.61-1.78) and number of subsequent overdoses (IRR = 1.74, 95% CI = 1.67-1.83). A total of 110 608 low back pain patients received naloxone prescriptions, and naloxone prescription was associated with subsequent opioid overdose (HR = 1.33, 95% CI = 1.27-1.40) and number of subsequent overdoses (IRR = 1.35, 95% CI = 1.29-1.41). Conclusions Receiving a naloxone prescription appears to be associated with increased risk of subsequent opioid overdose among patients with acute and chronic pain, suggesting prescribers often identify patients most in need of naloxone.

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Section: Discussionmentioning

confidence: 99%