Background:
Nonfatal opioid overdose is an opportunity to identify and treat substance use disorders, but treatment patterns after the overdose are unknown.
Objective:
To determine prescribed opioid dosage after an opioid overdose and its association with repeated overdose.
Design:
Retrospective cohort study.
Setting:
A large U.S. health insurer.
Participants:
2848 commercially insured patients aged 18 to 64 years who had a nonfatal opioid overdose during long-term opioid therapy for noncancer pain between May 2000 and December 2012.
Measurements:
Nonfatal opioid overdose was identified using International Classification of Diseases, Ninth Revision, Clinical Modification, codes from emergency department or inpatient claims. The primary outcome was daily morphine-equivalent dosage (MED) of opioids dispensed from 60 days before to up to 730 days after the index overdose. We categorized dosages as large (≥100 mg MED), moderate (50 to <100 mg MED), low (<50 mg MED), or none (0 mg MED). Secondary outcomes included time to repeated overdose stratified by daily dosage as a time-varying covariate.
Results:
Over a median follow-up of 299 days, opioids were dispensed to 91% of patients after an overdose. Seven percent of patients (n = 212) had a repeated opioid overdose. At 2 years, the cumulative incidence of repeated overdose was 17% (95% CI, 14% to 20%) for patients receiving high dosages of opioids after the index overdose, 15% (CI, 10% to 21%) for those receiving moderate dosages, 9% (CI, 6% to 14%) for those receiving low dosages, and 8% (CI, 6% to 11%) for those receiving no opioids.
Limitation:
The cohort was limited to commercially insured adults.
Conclusion:
Almost all patients continue to receive prescription opioids after an overdose. Opioid discontinuation after overdose is associated with lower risk for repeated overdose.
Primary Funding Source:
Health Resources and Services Administration.
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Author, Article and Disclosure Information
Grant Support: Dr. Larochelle was supported by the Health Resources and Services Administration (grants T32 HP10251 and T32 HP12706), Ryoichi Sasakawa Fellowship Fund, and Harvard Pilgrim Health Care Institute.
Disclosures: Dr. Larochelle reports grants from the Health Resources and Services Administration and Ryoichi Sasakawa Fellowship Fund and nonfinancial support from the Harvard Pilgrim Health Care Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0038.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer.
Reproducible Research Statement:Statistical code: Available from Dr. Larochelle (e-mail, marc.larochelle[email protected]). Study protocol and data set: Not available.
Corresponding Author: Marc R. Larochelle, MD, MPH, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118; e-mail, [email protected].
Current Author Addresses: Drs. Larochelle and Liebschutz: Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118.
Dr. Zhang, Mr. Ross-Degnan, and Mr. Wharam: Department of Population Medicine, Harvard Medical School, 133 Brookline Avenue, 6th Floor, Boston, MA 02215.
Author Contributions: Conception and design: M.R. Larochelle, J.M. Liebschutz, D. Ross-Degnan, J.F. Wharam.
Analysis and interpretation of the data: M.R. Larochelle, J.M. Liebschutz, D. Ross-Degnan.
Drafting of the article: M.R. Larochelle, J.F. Wharam.
Critical revision of the article for important intellectual content: M.R. Larochelle, J.M. Liebschutz, F. Zhang, D. Ross-Degnan, J.F. Wharam.
Final approval of the article: M.R. Larochelle, J.M. Liebschutz, F. Zhang, D. Ross-Degnan, J.F. Wharam.
Statistical expertise: F. Zhang.
Obtaining of funding: J.F. Wharam.
Administrative, technical, or logistic support: M.R. Larochelle, J.F. Wharam.
Collection and assembly of data: M.R. Larochelle, J.F. Wharam.
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