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Summaries for Patients |19 June 2018

Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes Free

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This article was published at Annals.org on 22 May 2018.
  • The full report is titled “Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012.” The authors are C.M. Carey, A.B. Jena, and M.L. Barnett.


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    • What is the problem and what is known about it so far?
    • Why did the researchers do this particular study?
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What is the problem and what is known about it so far?

Opioids are addictive narcotic substances that include both illegal drugs (heroin) and legal prescription medications used to treat pain. Opioids that are commonly prescribed in the United States include hydrocodone (an ingredient in Vicodin [AbbVie], Lortab [UCB], Zohydro [Pernix Ireland Pain Limited], and other brand-name drugs), oxycodone (an ingredient in such brand-name drugs as OxyContin [Purdue Pharma] and Percocet [Endo Pharmaceuticals]), and morphine. The United States currently has an epidemic of prescription opioid misuse, with high and rapidly growing numbers of overdose deaths. Physicians are increasingly being expected to examine patients' opioid prescription histories before prescribing these drugs. In fact, many states have laws requiring that physicians check patients' prescription histories using an online database before prescribing opioids. However, we lack information about the association of opioid use patterns with subsequent overdose to guide physicians examining these histories.

Why did the researchers do this particular study?

To identify patterns of opioid use related to an increased risk for overdose.

Who was studied?

More than 600,000 patients enrolled in Medicare from 2008 to 2012 who did not have a cancer diagnosis. Patients with cancer were excluded because relief of cancer pain is an appropriate and common use of opioids.

How was the study done?

The researchers identified several measures of opioid misuse that they thought might increase the risk for overdose on the basis of the quantity prescribed, overlapping prescriptions, use of more than 1 prescriber or pharmacy, and use of out-of-state prescribers or pharmacies. The investigators then used the Medicare data to determine whether patients had any of these patterns over a 6-month period and, if so, whether they had an overdose or died in the following year.

What did the researchers find?

All misuse measures examined had a positive association with subsequent opioid overdose and death. As the quantity of opioids or the number of prescribers or pharmacies increased, so did overdose risk.

What were the limitations of the study?

The study included only Medicare patients, so its results may not apply to younger patients or those with different or no health insurance.

What are the implications of the study?

Before prescribing opioids, physicians should see whether the patient's previous use shows the patterns associated with overdose found in this study.
This article was published at Annals.org on 22 May 2018.

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Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes. Ann Intern Med. ;168:I–18. doi: 10.7326/P18-0007

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Published: Ann Intern Med. 2018;168(12):I-18.

DOI: 10.7326/P18-0007

Published at www.annals.org on 22 May 2018

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2018 American College of Physicians
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Patterns of Potential Opioid Misuse and Subsequent Adverse Outcomes in Medicare, 2008 to 2012
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