Patient, Prescription-Related Factors Linked to Opioid Overdose

Patient factors, including Medicaid or Medicare Advantage, comorbid substance use disorder, medical comorbidities, and prescription-related factors, are associated with opioid overdose, according to a JAMA Network Open study.

The cohort study enrolled 236,921 opioid-naïve adult patients, of which 667 experienced an opioid overdose, from 2015 to 2018. The study outcome was an overdose event.

Most patients (59.2 percent) received hydrocodone as their initial opioid prescription, followed by oxycodone (26.1 percent). Other less common initiation periods included tramadol (7.8 percent) and codeine (4.9 percent).

During the six-month period, 81.9 percent of patients had one or two opioid prescriptions. And 55.7 percent had cumulative doses of 300 morphine milligram equivalents (MME) or more.

The overall rate of fatal or nonfatal opioid overdose was 120.6 per 100,000 people. But some patients had much higher opioid overdose rates. Researchers observed higher rates in patients with a history of comorbid substance use disorder.

The risk of overdose was highest among individuals 75 years of age and older compared to those aged 35 to 44, as well as those dually eligible for Medicaid and Medicare advantage versus those with commercial insurance.

Patients were also at an increased overdose risk if they filled oxycodone or tramadol compared with codeine, used benzodiazepines, concurrent opioids, and benzodiazepines, or filled opioids from three or more pharmacies over six months.

“This study found several patient and prescription-related risk factors that can provide guidance to clinicians, when either writing the initial opioid prescription or prescribing over the next several months, in the early period of a patient’s opioid prescription experience,” researchers stated in the study.

“These risk factors may be considered by prescribers to identify opioid-naive patients who may be most at risk for harm; to inform patient counseling and monitoring if opioids are prescribed; and to provide additional information on safe use, storage, and disposal of opioids and on signs of overdose,” they continued.

About three million US citizens and 16 million individuals globally suffered or currently suffer from opioid use disorder (OUD).

In April, The Biden Administration released new prescription drug policy priorities that address the opioid epidemic and reduce drug overdoses. The priorities also emphasize cross-cutting facets of the epidemic by ensuring racial equity in drug policy and promoting harm-reducing factors.

Expanding access to evidence-based treatment includes supporting a broader array of treatment and recovery supports.