Higher Opioid Dose Linked to Greater Overdose Risk

[Justin]

Higher prescribed doses of opioids for chronic pain significantly increased the risk of overdose, data from a large retrospective study showed...

Higher Opioid Dose Linked to Greater Overdose Risk (CME/CE, with audio) (click here for the full article at MedPage Today)

[Jack-of-all-trades]

Higher prescribed doses of opioids for chronic pain significantly increased the risk of overdose, data from a large retrospective study showed...

Higher Opioid Dose Linked to Greater Overdose Risk (CME/CE, with audio) (click here for the full article at MedPage Today)

I would love to see how this study was set up and repeated by someone else. The possibility of bias is great. When I see statements like"6 time or 9 times" without giving numbers I get suspicious. For instance 6 out of a million is 6 times higher than 1 out of a million but is still not very many. Another factor I thought of when I was reading this was those on higher doses are more inclined to give up and commit suicide. I'm sure there are others but retrospective studies need verification.

[Justin]

I would love to see how this study was set up and repeated by someone else. The possibility of bias is great. When I see statements like"6 time or 9 times" without giving numbers I get suspicious. For instance 6 out of a million is 6 times higher than 1 out of a million but is still not very many. Another factor I thought of when I was reading this was those on higher doses are more inclined to give up and commit suicide. I'm sure there are others but retrospective studies need verification.

Annals of Internal Medicine. January 19, 2010; vol. 152 no. 2 85-92

Opioid Prescriptions for Chronic Pain and Overdose
A Cohort Study

Kate M. Dunn, PhD; Kathleen W. Saunders, JD; Carolyn M. Rutter, PhD; Caleb J. Banta-Green, MSW, MPH, PhD; Joseph O. Merrill, MD, MPH; Mark D. Sullivan, MD, PhD; Constance M. Weisner, DrPH, MSW; Michael J. Silverberg, PhD, MPH; Cynthia I. Campbell, PhD; Bruce M. Psaty, MD, PhD; and Michael Von Korff, ScD. From Group Health Research Institute and University of Washington, Seattle, Washington; Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, United Kingdom; and Northern California Kaiser Permanente, Oakland, and University of California, San Francisco, California. © 2010 by the American College of Physicians

Background: Long-term opioid therapy for chronic noncancer pain is becoming increasingly common in community practice. Concomitant with this change in practice, rates of fatal opioid overdose have increased. The extent to which overdose risks are elevated among patients receiving medically prescribed long-term opioid therapy is unknown.

Objective: To estimate rates of opioid overdose and their association with an average prescribed daily opioid dose among patients receiving medically prescribed, long-term opioid therapy.

Design: Cox proportional hazards models were used to estimate overdose risk as a function of average daily opioid dose (morphine equivalents) received at the time of overdose.

Setting: HMO.

Patients: 9940 persons who received 3 or more opioid prescriptions within 90 days for chronic noncancer pain between 1997 and 2005.

Measurements: Average daily opioid dose over the previous 90 days from automated pharmacy data. Primary outcomes—nonfatal and fatal overdoses—were identified through diagnostic codes from inpatient and outpatient care and death certificates and were confirmed by medical record review.

Results: 51 opioid-related overdoses were identified, including 6 deaths. Compared with patients receiving 1 to 20 mg/d of opioids (0.2% annual overdose rate), patients receiving 50 to 99 mg/d had a 3.7-fold increase in overdose risk (95% CI, 1.5 to 9.5) and a 0.7% annual overdose rate. Patients receiving 100 mg/d or more had an 8.9-fold increase in overdose risk (CI, 4.0 to 19.7) and a 1.8% annual overdose rate.

Limitations: Increased overdose risk among patients receiving higher dose regimens may be due to confounding by patient differences and by use of opioids in ways not intended by prescribing physicians. The small number of overdoses in the study cohort is also a limitation.

Conclusion: Patients receiving higher doses of prescribed opioids are at increased risk for overdose, which underscores the need for close supervision of these patients.

Primary Funding Source: National Institute of Drug Abuse.

[Justin]

More and more Americans with chronic pain not caused by cancer are taking medically prescribed opioids like Oxycontin (oxycodone) and Vicodin (hydrocodone). The January 19 Annals of Internal Medicine features the first study to explore the risk of overdose in patients prescribed opioids for chronic noncancer pain in general health care.....

In Chronic Pain Patients, Higher Opioid Dose Linked To Overdose Risk (click here for the full article at Medical News Today)

[Justin]

Higher prescribed doses of opioids may increase overdose risk

Bloomberg News (1/19, Tirrell) reports that a paper published in the Annals of Internal Medicine reveals that "more doctors are prescribing oxycodone, morphine, and other opioid painkillers for back pain, arthritis, and headache." According to an accompanying editorial, written by A. Thomas McLellan, PhD, of the White House Office of National Drug Control Policy, "opioids are the most commonly prescribed class of medication in the US, with use of some such as methadone, increasing as much as 800 percent in the last 10 years." Aiming to understand the ramifications of that trend, researchers at the Seattle-based Group Health Research Institute "looked at pharmacy files for adults with chronic pain who had been given at least three opioid prescriptions over three months."

[New-disc]

Justin,


Thanks for the info

Todd