Clinical Edge

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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.

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