Risky opioid prescriptions linked to higher chance of death

June 18, 2018, RAND Corporation

When patients are prescribed opioids in risky ways, their chance of dying increases and their odds of death go higher as the number of risky opioid prescriptions increase, according to a new RAND Corporation study.

Studying prescription records for residents of Massachusetts over a five-year period, researchers identified six types of risky prescriptions and found that all were linked to a higher chance of death, including fatal opioid overdoses. The study found more than 6 percent of Massachusetts adults received a risky opioid prescription during the study period.

"Most people who misuse opioids are first exposed to the drugs through prescriptions so improving prescribing may be one way to reduce the risk of ," said Dr. Adam J. Rose, the study's lead and a physician scientist at RAND, a nonprofit research organization. "Our study suggests that state prescription monitoring programs may help identify inappropriate prescribing in real time."

The study is the first to examine such a broad array of subtypes of risky prescribing of opioids and link such prescribing to a wide array of fatal outcomes. The findings are published online by the Journal of General Internal Medicine.

Opioid use disorders affect an estimated 9 out of every 1,000 Americans and opioid overdose-related deaths have quadrupled over the past 15 years. Public health campaigns are underway to educate prescribers and patients about the danger of high-dose opioids, and the importance of keeping first prescriptions low in dose and limited in duration.

The RAND study makes use of a unique database maintained by Massachusetts that tracks prescriptions and can be linked at the patient level to other information such as mortality, demographics and ambulance records. The database includes information about more than 98 percent of the state's residents.

The study looked for evidence for six different types of risky prescribing of opioids: high-dose opioid prescriptions; prescribing of opioids along with the anti-anxiety medication benzodiazepines; opioids prescribed to an individual by four or more prescribers in a calendar year; filling opioid prescriptions at four or more pharmacies in a year; paying cash for an opioid prescription three or more times over a three-month period; prescribing opioids without documentation of a pain diagnosis.

Researchers linked these six types of risky prescribing with nonfatal opioid overdoses, fatal opioid overdoses and all other causes of mortality.

The study found that more than half of Massachusetts adults received at least one opioid prescription between 2011 and 2015. More than 11 percent of of those patients experienced at least one kind of risky opioid prescription.

Receiving a risky prescription was more common with increasing age, with more than 13 percent of patients age 80 and older receiving at least one. Researchers say the finding is at odds with the public image of the opioid crisis as a problem of young people, but researchers say older adults simply may receive more medications.

The strongest association for any cause of death was receiving a high-dose prescription for opioids and lacking a documented pain diagnosis. Five of the six kinds of risky were associated with a fatal opioid overdose. The exception was making cash payments for opioids.

"Our findings underscore the importance of potentially inappropriate prescribing of opioids as a contributing factor for fatal opioid overdoses and may help guide efforts to address the problem," Rose said. "This could provide the basis for a system that could flag providers in real time when they are writing a potentially inappropriate prescription for opioids."

Explore further: Doctors curbing first-time prescriptions for opioids

Related Stories

Doctors curbing first-time prescriptions for opioids

April 13, 2018
(HealthDay)—Although the opioid epidemic continues to rage in America, promising new data show that first-time opioid painkiller prescription rates have slowed in recent years.

Geography matters: Prescribing patterns for opioids in dermatology

February 7, 2018
A new study suggests that opioid prescribing is not widespread among dermatologists, but opportunities exist in concentrated areas to reduce their use. The study appears online Feb. 7 in JAMA Dermatology.

Inpatient opioid use and insufficient weaning pre-discharge may increase outpatient opioid prescript

May 21, 2018
According to the University of Pittsburgh School of Medicine scientists who conducted the study, theirs is the first large-scale evaluation of the impact of in-hospital opioid prescribing on post-discharge opioid use.

Dentist group puts teeth in push to curb opioid painkillers

March 26, 2018
The American Dental Association wants dentists to drastically cut back on prescribing opioid painkillers.

Nearly a quarter of Ontarians newly prescribed opioids received dose exceeding guidelines

May 16, 2018
Nearly a quarter (23.9 per cent) of initial opioid prescriptions in Ontario had a daily dose of more than 50 milligram morphine equivalents (MME), exceeding the suggested dose threshold for opioid prescriptions outlined in ...

Almost one in three patients used no opioids prescribed after surgery, survey finds

April 19, 2018
Nearly a third of patients responding to a Mayo Clinic survey said they used none of the opioids they were prescribed after surgery. The research findings, presented Thursday, April 19 at the American Surgical Association ...

Recommended for you

Study: What patients really think about opioid vs non-opioid medications for chronic pain

August 14, 2018
Prescriptions of opioids for chronic pain has increased dramatically since the 1990s in spite of their known harms. Despite a shortage of scientific studies on the long-term effectiveness of opioids such as morphine, oxycodone ...

Doctors nudged by overdose letter prescribe fewer opioids

August 9, 2018
In a novel experiment, doctors got a letter from the medical examiner's office telling them of their patient's fatal overdose. The response: They started prescribing fewer opioids.

Benzodiazepine and related drug prescriptions have increased among young people in Sweden

August 7, 2018
The prevalence rate of prescriptions for benzodiazepines and benzodiazepine-related drugs (BZD)—medications used to treat anxiety, insomnia, epilepsy and other neuropsychiatric conditions—increased by 22% between 2006 ...

Unwise opioids for wisdom teeth: Study shows link to long-term use in teens and young adults

August 7, 2018
Getting wisdom teeth removed may be a rite of passage for many teens and young adults, but the opioid painkiller prescriptions that many of them receive could set them on a path to long-term opioid use, a new study finds.

Behavioral nudges lead to striking drop in prescriptions of potent antipsychotic

August 1, 2018
A study led by Columbia University's Mailman School of Public Health has found that letters targeting high prescribers of Seroquel (quetiapine), an antipsychotic with potentially harmful side effects in the elderly, significantly ...

US opioid use not declined, despite focus on abuse and awareness of risk

August 1, 2018
Use of prescription opioids in the United States has not substantially declined over the last decade, despite increased attention to opioid abuse and awareness of their risks, finds a study published by The BMJ today.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.