Overdoses of opioid pain medications frequently occur in people who aren’t chronic users or who are prescribed low doses, according to a study in the August issue of Medical Care. The groups targeted by current opioid prescribing guidelines are those who receive high prescribed opioid doses.
“It may be prudent to revise guidelines to also address opioid poisonings occurring at relatively low prescribed doses and with acute and intermittent opioid use, in addition to chronic, high-dose use,” said lead author Dr. Deborah Fulton-Kehoe, a research scientist in the department of environmental and occupational health sciences at the University of Washington School of Public Health. Guidelines may also need to target prescription sedatives, which are involved in nearly half of opioid overdoses.
Dr. Fulton-Kehoe and colleagues analyzed Medicaid data on opioid prescribing and opioid poisoning in Washington state between 2006 and 2010. They identified 2,250 opioid overdoses occurring in 1,809 patients. About 35 percent of these events were associated with methadone, which can be used to treat heroin and other narcotic addictions, in addition to treating pain. The remaining 65 percent of overdoses were due to other opioid medications.
The researchers analyzed the prescription histories of patients with nonfatal overdose caused by opioid pain medications. Previous research has shown that both fatal and nonfatal overdoses were more likely for chronic opioid users and for those with higher prescribed opioid doses.
However, many patients in the study met neither of these criteria. Only 44 percent of patients who overdosed on opioid pain medications were chronic users with more than a 90-day supply of prescribed opioid medications in the prior year. In the week before the poisoning, only 17 percent of patients had a “yellow-flag” opioid dose targeted by the prescribing guideline: a (morphine-equivalent) dose of more than 120 milligrams per day. In contrast, 28 percent of overdose patients had a relatively low dose of less than 50 mg per day.