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Overdose and Prescribed Opioids FREE

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The summary below is from the full report titled “Opioid Prescriptions for Chronic Pain and Overdose. A Cohort Study.” It is in the 19 January 2009 issue of Annals of Internal Medicine (volume 152, pages 85-92). The authors are K.M. Dunn, K.W. Saunders, C.M. Rutter, C.J. Banta-Green, J.O. Merrill, M.D. Sullivan, C.M. Weisner, M.J. Silverberg, C.I. Campbell, B.M. Psaty, and M. Von Korff.

Ann Intern Med. 2010;152(2):I-42. doi:10.7326/0003-4819-152-2-201001190-00002
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What is the problem and what is known about it so far?

Opioids are narcotics that are used to treat pain. Examples include hydrocodone, oxycodone, codeine, morphine, propoxyphene, meperidine, methadone, and fentanyl. Doctors increasingly prescribe opioids for patients with chronic pain. Overdose and death rates from opioid poisoning are also increasing. However, it is unknown whether overdose is common in patients prescribed long-term opioid therapy for pain.

Why did the researchers do this particular study?

To estimate rates of overdose in patients prescribed opioids for chronic pain.

Who was studied?

9940 adults who received at least 3 opioid prescriptions within 90 days for chronic noncancer pain. Their mean age was 54 years, and 60% were women.

How was the study done?

The researchers searched pharmacy files for adults with chronic noncancer pain who were given at least 3 opioid prescriptions over a 3-month period. Chronic pain problems included back or neck pain, headache, jaw pain, arthritis, and menstrual pain. The researchers reviewed the medical records of these patients to see how many had had an overdose and used those numbers to estimate annual overdose rates.

What did the researchers find?

51 of 9940 adults receiving long-term opioid therapy for chronic noncancer pain had 1 or more overdose events. Six of these events were fatal. Estimated annual overdose rates were lowest in patients prescribed a low daily dose of opioid. For example, annual overdose rates were 0.2%, 0.7%, and 1.8% among patients receiving less than 20 mg, 50 to 99 mg, and more than 100 mg of opioids per day, respectively.

What were the limitations of the study?

There were few overdoses. Overdose events were assessed primarily through medical record review; some overdoses may have been missed or were not reported. Whether the dose-related differences in overdose rates were due to patient differences or to direct effects of higher doses was not clear.

What are the implications of the study?

Rates of overdose in adult patients receiving low doses of opioid therapy were lower than in patients receiving higher opioid doses, but most of the observed opioid overdoses occurred in patients receiving lower doses. Close medical supervision of patients receiving long-term opioid therapy for chronic noncancer pain is warranted.





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