Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients

Abstract

Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose.

Effect of Age on Opioid Prescribing, Overdose, and Mortality in Massachusetts, 2011 to 2015

“…Prescription opioids are a major cause of opioid‐related death, especially in older adults . PIP is associated with higher odds of nonfatal opioid overdose, fatal opioid overdose, and all‐cause mortality . In our study, age was by far the strongest predictor of undergoing PIP.…”

“…Similar to other studies, we identified exposure to 1 or more types of PIP, including: High‐dose opioids, defined according to the daily dose equivalent for each individual in each month in milligram morphine equivalents (MME) (Supplementary Appendix S2). We considered an individual to have received high‐dose opioids if his or her prescriptions averaged MME of 100 mg/d or more in 3 or more separate months. Overlapping opioid and benzodiazepine prescriptions, defined as opioid and benzodiazepine prescriptions that overlapped by at least 1 day in 3 or more separate months. Multiple opioid prescribers, defined as 4 or more opioid prescribers in any 3‐month period. Multiple opioid pharmacies, defined as opioids from 4 or more pharmacies in any 3‐month period. Lack of a documented pain diagnosis, defined as receiving opioids for 3 consecutive months without a pain diagnosis code on a medical service claim (Supplementary Appendix S3). …”

Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain

“…Opioid medications were recorded and converted to the equivalent daily dose of oral morphine (MEQ) using previously published conversion ratios (11,12). Prior publications suggest that opioid utilization patterns in chronic pain populations are nonnormally distributed (13,14). To address nonnormalcy, the number and percent of patients using any opioids and the median and interquartile range of opioids use is reported.…”

Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative‐Hypnotic Prescriptions among Veterans

“…Some of the highest risk combinations involve opioids taken with benzodiazepine and non‐benzodiazepine sedative‐hypnotics, which can increase overdose risk by potentiating depressant effects on the respiratory system (Jones, Mogali, and Comer ; Abrahamsson et al. ; Garg, Fulton‐Kehoe, and Franklin ; Sun et al. ).…”