Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

Chen, Qiushi; Larochelle, Marc R.; Weaver, Davis T.; Lietz, Anna P.; Mueller, Peter P.; Mercaldo, Sarah; Wakeman, Sarah E.; Freedberg, Kenneth A.; Raphel, Tiana J.; Knudsen, Amy B.; Pandharipande, Pari V.; Chhatwal, Jagpreet

doi:10.1001/jamanetworkopen.2018.7621

Cited by 235 publications

(186 citation statements)

References 29 publications

(41 reference statements)

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“…While judicious opioid prescribing may be associated with better outcomes among the opioid-naive, the same may not be true for those with a history of opioid dependence and/or addiction, particularly if reduced access to prescription opioid analgesics leads to substitution with riskier illicit opioids such as heroin and fentanyl [25,28,30,42]. While there is a general consensus that increased opioid prescribing initiated the recent epidemic of opioid addiction and overdose, focusing solely on opioid prescribing patterns is unlikely to stem the tide of opioidrelated harm [5,14,26,27,29,43]. Consistent with this idea, even among the opioid-naive individuals in this study, fentanyl was present at autopsy among nearly half of those who died of an opioid overdose, while approximately a quarter had alcohol, cocaine and/or marijuana as coingestants at the time of death.…”

Section: Discussionmentioning

confidence: 99%

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

et al. 2019

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Aims To examine how the risks of incident opioid use disorder (OUD), non‐fatal and fatal overdose have changed over time among opioid‐naive individuals receiving an initial opioid prescription. Design Retrospective, longitudinal study using the Massachusetts Chapter 55 data set, which linked multiple administrative data sets to study the opioid epidemic. We identified the cumulative incidence of OUD, non‐fatal and fatal overdose among the opioid‐naive initiating opioid treatment in Massachusetts from 2011 to 2014 and estimated rates of these outcomes at 6 months and at 1, 2, 3 and 4 years to 2015. We used Cox regression to examine the association between characteristics of the initial prescription and risk of these outcomes. Setting Massachusetts, USA. Participants Massachusetts residents aged ≥ 11 years in 2011–15 who were opioid‐naive (no opioid prescriptions or evidence of OUD in the 6 months prior to the index prescription) (n = 2 154 426). The mean age was 49.1 years, 55.3% were female and 47.3% had commercial insurance. Measurements Opioid prescriptions were identified in the Prescription Monitoring Program (PMP) database, as were the characteristics of the initial prescription database. The outcomes of OUD and non‐fatal overdose were identified from claims in the All Payer Claims Database (APCD) and hospital encounters in the acute hospital case mix files. Fatal overdoses were identified using Registry of Vital Records and Statistics (RVRS) death certificates and the Office of the Chief Medical Examiner (OCME) circumstances of death and toxicology reports. Findings Among opioid‐naive individuals receiving an initial opioid prescription, the risk of incident OUD appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. For example, the 1‐year OUD rate was 1.18% in 2011, 1.11% in 2012, 1.26% in 2013 and 0.94% in 2014. Longer therapy duration was associated with higher risk of OUD [hazard ratio (HR) = 2.24, 95% confidence interval (CI) = 2.19–2.29 for duration of 3 or more months], non‐fatal (HR = 1.67, 95% CI = 1.53–1.82) and fatal opioid overdose (HR = 2.24, 95% CI = 1.91–2.61). Concurrent benzodiazepine treatment was also associated with higher risk of OUD (HR = 1.14, 95% CI = 1.12–1.17), non‐fatal (HR = 1.20, 95% CI = 1.10–1.30) and fatal overdose (HR = 1.86, 95% CI = 1.61–2.16). Conclusions Among opioid‐naive individuals in Massachusetts receiving an initial opioid prescription, the risk of incident opioid use disorder appears to have declined between 2011 and 2014, while rates of overdose were largely unchanged. Longer therapy duration and concurrent benzodiazepines were associated with higher rates of opioid use disorder and opioid overdose.

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Section: Discussionmentioning

confidence: 99%

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

et al. 2019

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“…Opioid‐related overdoses in the United States resulted in approximately 48 000 deaths in 2017, primarily from illicitly manufactured fentanyl . Even with supply‐side solutions such as reductions in prescription opioid prescribing factored in, one research team has predicted that 700 000 people will die between 2016 and 2025 from opioid overdose . These increases have led to a rarely observed multiple year decline in life expectancy, and overdose is the leading cause of death in people less than 55 years old .…”

Section: Introductionmentioning

confidence: 99%

“…4 Even with supply-side solutions such as reductions in prescription opioid prescribing factored in, one research team has predicted that 700 000 people will die between 2016 and 2025 from opioid overdose. 5 These increases have led to a rarely observed multiple year decline in life expectancy, and overdose is the leading cause of death in people less than 55 years old. 6 Pharmacists most commonly address the crisis through naloxone dispensing and/or using the prescription drug monitoring program (PDMP).…”

Section: Introductionmentioning

confidence: 99%

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Bratberg

Smothers

Collins

et al. 2019

J Am Coll Clin Pharm

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Introduction Nearly 2.5 million Americans have an opioid use disorder (OUD) related to prescription and/or illicit opioids. Pharmacists, as one of the most accessible care providers, are essential in mitigating the mortality and morbidity of the opioid overdose crisis. Pharmacists are involved in numerous care activities related to this crisis and to caring for patients with an OUD. Objective The objective of this paper was to conduct a literature review to highlight several pharmacist‐driven practices that provide a broad range of prevention, harm reduction, treatment, and recovery services to patients affected or potentially affected by the opioid crisis. Methods Articles had to meet the criteria of describing pharmacist‐led practice related to providing care to patients at risk of an opioid overdose, with an OUD, or related to opioid safety. The literature search was conducted in 2018 and utilized numerous sources including: OneSearch (EBSCOhost), PubMed, ScienceDirect, and the Journal of the American Pharmacists Association Opioid Topic Collection. Results Seven articles were chosen for inclusion in this review. These studies report on innovative programs and practices that describe the role of pharmacists in the opioid crisis. Studies demonstrate the types of involvement pharmacists have in caring for patients throughout the care continuum: actively engaged in upstream interventions aimed at preventing misuse and improve safety; screening and monitoring opioid prescribing and usage; providing access to naloxone; and, assisting in the recovery and rehabilitation process of patients with OUD, including collaboratively managing OUD with evidence‐based pharmacotherapy. Conclusion The studies included in our narrative review demonstrate how innovative programs and practices can expand the role of pharmacists throughout the entire spectrum of interventions applied to the opioid crisis by capitalizing on their existing skill sets and knowledge.

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“…4 Projections revealed if current prevention and intervention strategies do not change by 2025, the rate of misuse and overdose death will rise by 61%. 5 In response to the epidemic, multiple federal, state, and local agencies have implemented various strategies to address the opioid crisis. Current interventions such as increasing availability of naloxone are projected to result in approximately a 4% reduction in opioid-related deaths.…”

Section: Introductionmentioning

confidence: 99%

“…6 Overall, these strategies are found to have minimal impact preventing only 3.0-5.3% of overdose deaths. 5 Studies by Chen and colleagues 5 and Pitt and colleagues 6 have further revealed that current universal interventions are not enough to address the multidimensional and dynamic aspects of the opioid epidemic. Improving universal opioid prevention strategies to more tailored approaches has been suggested.…”

Section: Introductionmentioning

confidence: 99%

Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model

Ishino¹,

Gilreath²,

Salmeron³

et al. 2020

Preprint

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Background Few studies have comprehensively and contextually examined the relationship of variables associated with opioid misuse. Our purpose was to fill a critical gap in comprehensive risk models of opioid misuse in the United States by identifying the most salient predictors. MethodsA multivariate logistic regression was used on the 2017 and 2018 National Survey on Drug Use and Health, which included all 50 states and the District of Columbia of the United States. The sample included all noninstitutionalized civilian adults aged 18 and older (N=85,580; weighted N=248,008,986). The outcome of opioid misuse was based on reported prescription pain reliever and/or heroin dependence or abuse. Biopsychosocial predictors of opioid misuse in addition to sociodemographic characteristics and other substance dependence or abuse were examined in our comprehensive model. Biopsychosocial characteristics included socioecological and health indicators.Criminality was the socioecological indicator. Health indicators included self-reported health, private health insurance, psychological distress, and suicidality. Sociodemographic variables included age, sex/gender, race/ethnicity, sexual identity, education, residence, income, and employment status. Substance dependence or abuse included both licit and illicit substances (i.e., nicotine, alcohol, marijuana, cocaine, inhalants, methamphetamine, tranquilizers, stimulants, sedatives). Results The comprehensive model found that criminality (adjusted odds ratio [AOR]=2.58, 95% confidence interval [CI]=1.98-3.37, p<0.001), self-reported health (i.e., excellent compared to fair/poor [AOR=3.71, 95%CI=2.19-6.29, p<0.001], good [AOR=3.43, 95%CI=2.20-5.34, p<0.001], and very good [AOR=2.75, 95%CI=1.90-3.98, p<0.001]), no private health insurance (AOR=2.12, 95%CI=1.55-2.89, p<0.001), serious psychological distress (AOR=2.12, 95%CI=1.55-2.89, p<0.001), suicidality (AOR=1.58, 95%CI=1.17-2.14, p=0.004), and other substance dependence or abuse were significant predictors of opioid misuse. Substances associated were nicotine (AOR=3.01, 95%CI=2.30-3.93, p<0.001), alcohol (AOR=1.40, 95%CI=1.02-1.92, p=0.038), marijuana (AOR=2.24, 95%CI=1.40-3.58, p=0.001), cocaine (AOR=3.92, 95%CI=2.14-7.17, p<0.001), methamphetamine (AOR=3.32, 95%CI=1.96-5.64, p<0.001), tranquilizers (AOR=16.72, 95%CI=9.75-28.65, p<0.001), and stimulants (AOR=2.45, 95%CI=1.03-5.87, p=0.044).

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Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States

Cited by 235 publications

References 29 publications

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

Trends in opioid use disorder and overdose among opioid‐naive individuals receiving an opioid prescription in Massachusetts from 2011 to 2014

Pharmacists and the opioid crisis: A narrative review of pharmacists' practice roles

Biopsychosocial factors associated with opioid misuse in a 2017-2018 United States national survey: A comprehensive multivariate model

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