More than 90% of patients with chronic pain continue to receive prescription opioids after an overdose, putting them at high risk for a future overdose, according to research published in the journal Annals of Internal Medicine.
Abuse of and addiction to opioids such as heroin, morphine and prescription pain relievers is a serious problem that impacts the health, social and economic welfare of societies worldwide.
Globally, it is estimated that 26-36 million people abuse opioids. In 2012, the US saw an estimated 2.1 million individuals with substance use disorders related to prescription opioid pain relievers, as well as an estimated 467,000 people addicted to heroin.
The number of unintentional overdose deaths from prescription pain relievers in the US has more than quadrupled since 1999, and there is growing evidence that a rise in nonmedical use of opioid analgesics is linked to heroin abuse in the US.
If a patient has a nonfatal opioid overdose, it should be a warning sign and an opportunity to identify and treat any substance use disorders; but there is little information about treatment patterns after the overdose.
Researchers used information from Optum, a large national commercial insurance claims database with data on 50 million individuals over a 12-year period, to identify nearly 3,000 patients who experienced a nonfatal overdose while taking opioids prescribed for chronic pain.
The data showed that, following the overdose, prescription of opioids continued for 91% of patients. In addition, 70% of patients received prescriptions from the same provider who prescribed the opioids before their initial overdose.
Then, 2 years later, patients who continued taking high dosages of opioids were twice as likely to have another overdose, compared with those who stopped using opioids after the overdose.
- The rate of death by overdose in the US in 2013 was 13.8 per 100,000 people
- Overdose risk is associated with doses exceeding 100 morphine milligram equivents (MME) per day
- In eight US states, 1% of providers prescribed 50% of opioid prescriptions.
The authors say the findings highlight the challenges faced by physicians to balance the known risks with potential benefits of prescription opioids for patients with chronic pain.
Their research would appear to reinforce the need to develop tools that will help identify and treat patients at risk for opioid use disorders and/or overdose.
Previous research, published by the National Institutes on Drug Abuse, says the current problem is partly due to drastic increases in the number of prescriptions written and dispensed, as well as increased social acceptability for using medications for different purposes, and aggressive marketing by pharmaceutical companies.
As a result, there is greater “environmental availability” of prescription medications in general and especially opioid analgesics, says Nora Volkow, who presented the research at the Senate Caucus on International Narcotics Control.
Volkow points out that the total number of opioid pain relievers prescribed in the US, the biggest consumer of prescription opioids globally, has risen from around 76 million in 1991 to nearly 207 million in 2013.
At the same time, emergency department visits involving nonmedical use of opioid analgesics are estimated to have increased from 144,600 in 2004 to 305,900 in 2008; treatment admissions for abuse of nonheroin opiates increased from 1% of all admissions in 1997 to 5% in 2007; and overdose deaths due to prescription opioid pain relievers have more than tripled in the last 2 decades, reaching 16,651 deaths in the US in 2010.
Medical News Today recently reported that 50% of methadone clinic patients became addicted to opioids after using prescription painkillers.