Patients at Risk for Opioid Overdose can be Identified through Prescription Drug Monitoring Programs

Prescription opioid overdose deaths have increased dramatically in the U.S. in recent years. To address this problem, most states have established prescription drug monitoring programs (PDMP). Researchers used data from the Tennessee PDMP to compare individuals who had an opioid-related death in 2009/2010 with randomly selected age and sex-matched controls who had also received at least one opioid prescription in the year prior to the death of the matched case.

• Each year, approximately 2 million Tennessee residents filled an opioid prescription, nearly one-third of the state population. Rates increased from 2007 to 2011 and were higher for women and for people in rural counties.
• There were 932 opioid-related deaths during the 24 months studied; 592 (64%) were patients in the PDMP.
• Opioid-related deaths were associated with having 4 or more prescribers (adjusted odds ratio [aOR], 6.5), using 4 or more pharmacies (aOR, 6.0), and receiving more than 100 mg of morphine milligram equivalents daily (aOR, 11.2); 55% of individuals who died had at least 1 of these risk factors and 6% had all 3.

Comments:

This study confirms prior observations that dose prescribed and number of prescribers and pharmacies are associated with an increased risk of opioid overdose. The number of individuals at risk steadily increased during this time period despite the availability of the PDMP, suggesting that access to this data alone does not change practitioner behavior.

Darius A. Rastegar, MD

Reference:

Baumblatt JA, Wiedeman C, Dunn JR, et al. High-risk use by patients prescribed opioids for pain and its role in overdose deaths. JAMA Intern Med. 2014;174(5):796–801.