Prescribed Opioids: Overdoses Not Uncommon
Higher Doses Linked to Higher Risk, Study Finds
By Salynn Boyles
WebMD Health News
Reviewed By Louise Chang, MD
Jan. 19, 2010 -- Overdoses and drug-related deaths are not uncommon among people taking opioid drugs that have been prescribed by a doctor for chronic pain, a new government-funded study finds.
The finding suggests an urgent need to more closely monitor patients who are prescribed drugs like OxyContin, Vicodin, and methadone for long-term use, as well as the need to reassess current prescribing practices, an Obama administration official noted.
“The threat to patient safety is too great to allow current pain management and opioid prescribing practices to remain as they are,” White House Office of National Drug Control Policy Deputy Director A. Thomas McLellan, PhD, writes in an editorial published along with the study in the journal Annals of Internal Medicine.
CDC: Opioid Deaths Have Tripled
Opioid drugs are increasingly prescribed long term for the treatment of non-cancer-related pain such as back pain and degenerative arthritis.
Prescriptions for methadone alone have increased by more than 800% in the United States in the last decade, and methadone-related deaths have risen more than sevenfold.
According to the CDC, deaths from opioid use more than tripled in the U.S. from 1999 to 2006, from 4,000 to 13,800.
It is widely believed that most opioid-related overdoses and deaths occur among people who abuse the drugs, either by obtaining them without a prescription or by "doctor shopping" to illegally get the drugs from multiple providers.
Little research has been done to examine overdose risk among patients taking medically prescribed opioids.
In an effort to better understand the rate of fatal and nonfatal overdoses among patients taking prescribed opioids for chronic pain, researchers studied nearly 10,000 such patients enrolled in a Seattle-based health cooperative.
All the patients had received three or more opioid prescriptions within a period of 90 days for non-cancer pain between 1997 and 2005. The patients were followed for an average of 42 months from their initial 90-day exposure.
During this time, there were 51 serious overdoses resulting in hospital treatment or admission, including six deaths.
Patients treated with higher opioid doses (100 milligrams per day or more) were nine times more likely to overdose than those treated with low doses (maximum of 20 milligrams per day).
But most of the overdoses occurred in patients taking under 100 milligrams per day because higher-dose prescriptions were not as common.
7 Nonfatal Overdoses for Every Drug Death
The analysis also found that:
- Opioid overdoses occurred at similar rates across all age groups.
- The estimated annual overdose rates were 0.2%, 0.7%, and 1.8% among patients receiving less than 20 milligrams a day, 50 to 99 milligrams a day, and 100 or more milligrams a day, respectively, of opioids.
- Suicide attempts and drug abuse were cited as contributing to overdose in only a minority of cases.
- More than seven nonfatal overdoses occurred for every fatal overdose among the study participants.
The study was funded by the National Institute of Drug Abuse.
“Most of the attention has been on fatal overdoses because that is the data we have had,” senior investigator Michael Von Korff, ScD, of the Group Health Research Institute, tells WebMD. “But this study makes it clear that serious non-fatal overdoses are not uncommon among these patients.”
The message to physicians who prescribe drugs like OxyContin, Vicodin, and methadone for chronic pain is clear, Von Korff says.
“If a patient is using opioids long term, these drugs should be prescribed by a single physician who is aware of all the drugs the patient is taking,” he says.
The message to patients is that they should never take more of a prescription opioid for pain than is prescribed.
“The recent (opioid-related) mortality data from CDC has been sobering,” he says. “This study confirms that we need to be concerned about the full spectrum of patients taking these drugs and not just those struggling with substance abuse.”
Dunn, K.M., Annals of Internal Medicine, Jan. 19, 2010; vol 152: pp 85-92.
Michael Von Korff, ScD, Group Health Research Institute, Group Health Cooperative, Seattle.
News release; Group Health Cooperative Center for Health Studies, Seattle.
WebMD Health News: "CDC: Alarming Increase in Methadone Deaths."
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