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.
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.
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