Opioid Prescribing Interventions to Decrease Opioid Use Disorder and Overdose Likely Miss At-risk Patients

Recent clinical guidelines in the US have cautioned against the prescription of high-dose opioid medications (>90mg morphine equivalent dose [MED] per day), particularly for chronic pain, and many clinicians have adjusted their practice accordingly. This cross-sectional study of commercially insured adults (N=227,038) with a new diagnosis of opioid use disorder (OUD) or opioid overdose examined patterns of opioid prescribing in the 12 months prior to diagnosis.

• 51% of patients in the study had a diagnosis of chronic pain.
• 35% of patients with incident OUD or opioid overdose were not prescribed an opioid in the year before their diagnosis.
• From 2006–2016, the proportion of patients not receiving a prescription opioid in the year before their OUD or opioid overdose diagnosis increased by 86%.
• Among the 65% of patients who received an opioid prescription prior to their diagnosis of OUD or opioid overdose, most were prescribed >20mg MED per day; only 13% were prescribed high-dose opioid medications (>150mg MED per day).

Comments: This study highlights the limitations of opioid prescription-focused interventions to prevent the development of OUD and opioid overdose, but confirms that even patients who are prescribed lower doses of opioid medications can be at risk. Although opioid prescriptions have reduced overall in the US since 2006, opioid overdoses remain high due to fentanyl contamination of the US drug supply and ongoing barriers to OUD treatment. Without a systematic approach to addressing OUD and opioid overdose, interventions that focus on prescription opioids alone will continue to fall short.

Melissa Weimer, DO, MCR

Reference: Wei YJ, Chen C, Fillingim R, et al. Trends in prescription opioid use and dose trajectories before opioid use disorder or overdose in US adults from 2006 to 2016: A cross-sectional study. PLoS Med. 2019;16(11):e1002941.