Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Patterns of Opioid Misuse & Adverse Outcomes

Ann Intern Med; ePub 2018 May 22; Carey, et al

In order to fully assess patients’ opioid overdose risk, clinicians should examine a wide range of misuse patterns, a recent study suggests. The observational study compared outcomes for Medicare enrollees with potential opioid misuse patterns vs those for beneficiaries with no such problems from 2008 to 2012. Researchers examined a 5% sample of beneficiaries who had an opioid prescription without a cancer diagnosis. Opioid misuse was defined based on drug quantity, overlapping prescriptions, use of multiple prescribers or pharmacies, and use of out-of-state prescribers or pharmacies. The primary outcome was a diagnosis of opioid overdose in the year after a 6-month index period. Among the findings:

  • Overall, 0.6% to 8.5% of beneficiaries fulfilled a misuse measure.
  • Subsequent opioid overdose was positively associated with successively greater numbers of prescribers or pharmacies or higher opioid quantities.
  • Subsequent overdose risk increased with any deviation in the single prescriber-single pharmacy opioid use pattern.
  • All misuse measures had a positive association with subsequent opioid overdose and death.

Citation:

Carey CM, Jena AB, Barnett ML. Patterns of potential opioid misuse and subsequent adverse outcomes in Medicare, 2008 to 2012. Ann Intern Med. [Published online ahead of print May 22, 2018]. doi:10.7326/M17-3065.

This Week's Must Reads

Relevance of Health Literacy to CV Health, Circulation; ePub 2018 Jun 4; Magnani, et al

Diabetes & Long-Term Kidney Disease, Diabetes Care; ePub 2018 Jun 1; Warren, et al

Maternal Loss of Control Over Eating, Am J Clin Nutr; ePub 2018 Jun 5; Micali, et al

Efficacy of Brief Behavioral Treatment for Insomnia, Sleep Medicine; ePub 2018 Jun 2; McCrae, et al

Opioid-Related Adverse Events in Surgical Patients, JAMA Surg; ePub 2018 May 23; Shafi, et al

Must Reads in Pain

Opioid-Related Adverse Events in Surgical Patients, JAMA Surg; ePub 2018 May 23; Shafi, et al

Patterns of Opioid Misuse & Adverse Outcomes, Ann Intern Med; ePub 2018 May 22; Carey, et al

Reduced Opioid Exposure in Hospitalized Patients, JAMA Intern Med; ePub 2018 May 14; Ackerman, et al

Psychological Interventions & Chronic Pain Reduction, JAMA Intern Med; ePub 2018 May 7; Niknejad, et al

Reasons for Analgesic Use in Chronic Pain, Clin J Pain; ePub 2018 Apr 24; Vowles, et al