Higher Prescribed Opioid Doses Are Associated with Overdose Deaths

Opioid prescribing has risen dramatically in the past 2 decades accompanied by a rise in unintentional overdose deaths. This study used Department of Veterans Affairs prescription and diagnosis data from patients who received medical care in 2004 or 2005 to compare the 750 subjects with unintentional opioid overdose death by the end of 2008 with a random sample of 154,684 subjects who received opioids for pain. Patients prescribed methadone were not included.

• The estimated overall risk of overdose was 0.04%.

• In the unadjusted analysis, subjects who overdosed were more likely to have had chronic or acute pain as well as a substance use disorder or psychiatric diagnosis and were less likely to have had cancer.

• In adjusted analyses of subgroups with chronic pain, cancer, acute pain, or substance use disorders, an increased risk of overdose death was seen in morphine dose equivalents of ≥50 mg per day in all 4 groups.

Comments:

This study confirms prior observations of an association between opioid dose and overdose risk and points out that this is also a concern for patients with cancer. Although the overall risk of fatal overdose appeared to be low, a limitation of this and other studies is how the cause of death is determined; deaths are not always investigated, particularly when the decedent is older or had chronic medical problems.

Darius A. Rastegar, MD

Reference:

Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315–1321.