A Comparison of Overdose Risk Behaviors and Knowledge Among Patients Receiving Opioid Medications for Opioid Use Disorder and Pain

Individuals receiving opioids for chronic pain may be at risk for opioid overdose (OOD), but the need for overdose education remains unknown. Investigators sought to identify risk factors and determine the risk awareness for OOD among US veterans, receiving medical care within the Veterans Administration, treated with opioids for chronic pain (n=38) and compared them with those treated with methadone or buprenorphine for opioid use disorder (OUD, n=52). Participants completed a questionnaire assessing OOD risk factors, knowledge, and self-estimate of overdose risk.

• The median total daily morphine equivalent (ME) dose prescribed was 35 ME among those receiving treatment for chronic pain and 430 ME for those with OUD.
• Patients receiving treatment for chronic pain demonstrated multiple OOD risk factors, but fewer than those with OUD (5.9 versus 8.5).
• Knowledge of OOD risk factors was also lower among patients receiving treatment for chronic pain compared with those with OUD.
• 70% of all study participants, irrespective of group, believed their OOD risk was below that of the average American adult.

Comments:

Though limited by its small sample size and single-site recruitment, this study suggests that patients prescribed opioids for chronic pain have multiple opioid overdose risk factors and underestimate their risk for overdose. Given the recent rise in overdoses, findings from this study indicate that education for overdose prevention may need to be broadened to include patients prescribed opioids for chronic pain who are at increased risk for overdose. Future research should focus on better characterizing specific opioid overdose risk factors and risk awareness among patients prescribed opioids for chronic pain.

Seonaid Nolan, MD

Reference:

Wilder CM, Miller SC, Tiffany E, et al. Risk factors for opioid overdoses and awareness of overdose risk among veterans prescribed chronic opioids for addiction or pain. J Addict Dis. 2016;35(1):42–51.