Chronic Opioid Therapy Risk Reduction Initiatives Did Not Reduce Opioid Overdose

Little is known about the effects of primary care-based opioid dose reduction and risk stratification/monitoring (RSM) interventions on the risk of opioid overdose. This study used an interrupted time series analysis to compare: 1) opioid overdose rates among patients in clinics that implemented a dose reduction intervention followed by a RSM intervention; with 2) overdose rates among patients in clinics without the sequential interventions.

• From 2006 to 2014, 22,673 intervention patients (in 26 group practice clinics) and 8469 control patients (in diverse contracted care practices) experienced 311 fatal or non-fatal opioid overdoses.
• In the primary analysis, neither the opioid dose reduction nor the RSM intervention were associated with reduced opioid overdose rates among patients receiving chronic opioid therapy.
• In planned secondary analyses, overdose rates decreased significantly in intervention settings during the dose reduction phase (relative annual change, 0.83), but not in the control settings. No changes in overdose rates were seen during the RSM intervention phase.

Comments: These data are limited by potential differences in the intervention and control settings, although efforts were made to control for patient differences. Since the study only examined overdose rates among patients currently prescribed opioids, possible effects on overdose among patients whose opioids were discontinued are not included, and the design did not allow reporting of any differential opioid discontinuation rates between settings. Studies of the effects of opioid dose reduction and discontinuation on opioid overdose among patients receiving chronic opioid therapy are urgently needed.

Joseph Merrill, MD, MPH

Reference: Von Korff M, Saunders K, Dublin S, et al. Impact of chronic opioid therapy risk reduction initiatives on opioid overdose. J Pain. 2019;20(1):108–117.