Risk factors for severe respiratory depression from prescription opioid overdose

Fox, Lindsay; Hoffman, Robert S.; Vlahov, David; Manini, Alex F.

doi:10.1111/add.13925

Cited by 49 publications

(39 citation statements)

References 18 publications

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“…Escalating use of fentanyl for the treatment of chronic noncancer pain has also been documented elsewhere (Australia, Scandinavian countries). Pharmaceutical fentanyl, with a potency 50‐100 times higher than morphine, greatly increases opioid‐related risks (eg, high overdose and abuse potential) …”

Section: Discussionmentioning

confidence: 99%

Trends in opioid prescribing in Estonia (2011‐2017)

Uusküla

Raag

Kurvits³

et al. 2020

Pharmacology Res & Perspec

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Our objective was to examine the trends and variation in opioid prescribing in Estonia from 2011 to 2017. This retrospective cross‐sectional study is based on a nationwide prescription medicines database. We stratified the analysis by treatment indication (cancer vs noncancer pain). Between 2011 and 2017, annual opioid prescribing rates increased by 67% (from 82.9 to 138.6 prescriptions per 1000 population). The annual number of prescriptions per patient did not change substantially (from 2.94 in 2011 to 2.87 in 2017), and was higher among cancer patients (5.07 vs 2.67 annual prescriptions per cancer and noncancer patients, respectively, in 2017). The use of the most potent opioids (morphine, fentanyl) was higher in noncancer than in cancer patients. The use of prescription opioids is low, and raises concern about the potential undertreatment of cancer pain, in parallel with misuse of opioids for either noncancer pain or diversion.

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Section: Discussionmentioning

confidence: 99%

Trends in opioid prescribing in Estonia (2011‐2017)

Uusküla

Raag

Kurvits³

et al. 2020

Pharmacology Res & Perspec

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“…They showed that the risk factors for severe respiratory depression in patients with prescription opioid overdose include drug misuse (pertinent for methadone), increased age, and the speci c opioid medication involved. In that study, methadone had a much higher risk of severe respiratory depression [21]. Other studies revealed that a history of a substance use disorder was closely associated with the development of opioid-induced respiratory depression, with an odds ratio of 12.7 [22].…”

Section: Discussionmentioning

confidence: 70%

Clinical characteristics and time trends of hospitalized methadone exposures s in the United States based on the Toxicology Investigators Consortium (ToxIC) Case Registry: 2010-2017

Mehrpour

Hoyte

Amirabadizadeh

et al. 2020

Preprint

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Background: Methadone is well known for its long duration of action and propensity for mortality after an overdose. The present research was aimed at evaluating the clinical manifestations and time trends of methadone exposure in patients in US hospitals.Methods: We queried the American College of Medical Toxicology's Toxicology Investigators Consortium case registry for all cases of methadone exposure between January 1, 2010, and December 31, 2017. The collected information included demographic features, clinical presentations, therapeutic interventions, poisoning type (acute, chronic, or acute on chronic), and the reason(s) for exposure. Descriptive data and relative frequencies were used to investigate the participants' characteristics. Our data analysis was performed using SPSS version 19 and Prism software. The trends and clinical manifestations of methadone poisoning over the time period of the study were specifically investigated.Results: Nine hundred and seventy-three patients who met our inclusion criteria, with a mean age of 41.9 ± 16.6 years (range: 11 months-78 years) were analyzed. Five hundred eighty-two (60.2%) were male. The highest rate of methadone poisoning was observed in 2013. There was an increasing rate of methadone exposures in 2010–2013, followed by a decline in 2014–2017. The most common clinical manifestations in methadone-poisoned patients were coma (48.6%) and respiratory depression (33.6%). The in-hospital mortality rate of methadone poisoning was 1.4%.Conclusion: ToxIC Registry data showed that inpatient methadone exposures enhanced from 2010 to 2013, after which a reduction occurred in the years 2014 to 2017.

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“…The risk for respiratory depression due to fentanyl, which is directly linked to death, 20) has been frequently reported. [21][22][23] Therefore, caution should be certainly paid for ensuring the appropriate use of fentanyl. Nevertheless, in the past 10 years, respiratory depression leading to deaths related with fentanyl has been sometimes reported.…”

Section: Discussionmentioning

confidence: 99%

Current Status of Adverse Events Related with Opioid Analgesics in Japan: Assessment Based on Japanese Adverse Drug Event Report Database

Suga

Uchida

Suzuki

et al. 2019

Biological & Pharmaceutical Bulletin

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Opioid analgesics have greatly contributed to the advancement of pain management. However, although opioids have been appropriately used in Japan, they rarely induce serious adverse events, such as respiratory depression. The present study aimed to investigate the temporal changes in the occurrence of opioid-related adverse events and deaths between 2004 and 2017 in Japan using the Japanese Adverse Drug Event Report (JADER) database. We analyzed the following points using data extracted from JADER website: 1) temporal changes in the number and proportion of opioid-related adverse event reports; 2) temporal changes in the number of morphine-, oxycodone-, and fentanyl-related adverse event reports per annual consumption; and 3) cases in which the reported outcome following opioid-related adverse events was death. Our results showed no dramatic changes in the overall incidence of opioid-related adverse events, despite the temporal changes in the annual consumption and shared component of each opioid during the survey period. However, the number and rate of fentanyl-related adverse events and their outcome "death" increased since 2010, being the highest among all adverse event including those related to morphine and oxycodone. Outcome "death" by fentanyl-related adverse events was caused mainly due to respiratory depression. These findings suggest that, although opioid-related adverse events can be controlled through proper monitoring and management by medical personnel in Japan, extra caution should be continuously paid for the rare but serious fentanylinduced adverse events.

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Risk factors for severe respiratory depression from prescription opioid overdose

Abstract: In emergency department patients in the United States with prescription opioid overdose, worse clinical severity was associated with opioid misuse, increased with age and was widely variable, depending on the specific opioid medication involved.

Cited by 49 publications

References 18 publications

Trends in opioid prescribing in Estonia (2011‐2017)

Trends in opioid prescribing in Estonia (2011‐2017)

Clinical characteristics and time trends of hospitalized methadone exposures s in the United States based on the Toxicology Investigators Consortium (ToxIC) Case Registry: 2010-2017

Current Status of Adverse Events Related with Opioid Analgesics in Japan: Assessment Based on Japanese Adverse Drug Event Report Database

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