Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients
The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk. To determine whether patterns of opioid use are associated with risk of opioid-related...
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| Veröffentlicht in: | Medical care 2017-07, Vol.55 (7), p.661-668 |
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| description | The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk.
To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users.
This is a retrospective cohort study.
In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid.
Average daily dose (morphine equivalents), opioid schedule/duration of action, sedative-hypnotic use.
Compared with patients at 1-19 mg/d, risk of opioid overdose death significantly increased at 50-89 mg/d [adjusted hazard ratio (aHR), 2.3; 95% confidence interval (CI), 1.4-4.1], 90-119 mg/d (aHR, 4.0; 95% CI, 2.2-7.3), 120-199 mg/d (aHR, 3.8; 95% CI, 2.1-6.9), and ≥200 mg/d (aHR, 4.9; 95% CI, 2.9-8.1). Patients using long-acting plus short-acting Schedule II opioids had 4.7 times the risk of opioid overdose death than non-Schedule II opioids alone (aHR, 4.7; 95% CI, 3.3-6.9). Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death (aHR, 6.4; 95% CI, 5.0-8.4). Risk was particularly high for opioids combined with benzodiazepines and skeletal muscle relaxants (aHR, 12.6; 95% CI, 8.9-17.9). Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics (aHR, 5.6; 95% CI, 1.6-19.3).
Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose. |
| doi_str_mv | 10.1097/MLR.0000000000000738 |
| format | Article |
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To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users.
This is a retrospective cohort study.
In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid.
Average daily dose (morphine equivalents), opioid schedule/duration of action, sedative-hypnotic use.
Compared with patients at 1-19 mg/d, risk of opioid overdose death significantly increased at 50-89 mg/d [adjusted hazard ratio (aHR), 2.3; 95% confidence interval (CI), 1.4-4.1], 90-119 mg/d (aHR, 4.0; 95% CI, 2.2-7.3), 120-199 mg/d (aHR, 3.8; 95% CI, 2.1-6.9), and ≥200 mg/d (aHR, 4.9; 95% CI, 2.9-8.1). Patients using long-acting plus short-acting Schedule II opioids had 4.7 times the risk of opioid overdose death than non-Schedule II opioids alone (aHR, 4.7; 95% CI, 3.3-6.9). Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death (aHR, 6.4; 95% CI, 5.0-8.4). Risk was particularly high for opioids combined with benzodiazepines and skeletal muscle relaxants (aHR, 12.6; 95% CI, 8.9-17.9). Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics (aHR, 5.6; 95% CI, 1.6-19.3).
Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose.</description><identifier>ISSN: 0025-7079</identifier><identifier>EISSN: 1537-1948</identifier><identifier>DOI: 10.1097/MLR.0000000000000738</identifier><identifier>PMID: 28614178</identifier><language>eng</language><publisher>United States: Wolters Kluwer Health, Inc</publisher><subject>Adolescent ; Adult ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - poisoning ; Benzodiazepines ; Chronic Pain - drug therapy ; Confidence intervals ; Death ; Disease control ; Drug overdose ; Drug Overdose - mortality ; Female ; Government programs ; Health care ; Humans ; Hypnotics ; Male ; Medicaid ; Middle Aged ; Morphine ; Mortality ; Muscle relaxants ; Musculoskeletal system ; Narcotics ; Opioid receptors (type delta) ; Original Article ; Overdose ; Pain ; Patients ; Retrospective Studies ; Risk Assessment ; Skeletal muscle ; Thresholds ; United States - epidemiology ; Young Adult</subject><ispartof>Medical care, 2017-07, Vol.55 (7), p.661-668</ispartof><rights>Copyright © 2017 Wolters Kluwer Health, Inc.</rights><rights>Copyright Lippincott Williams & Wilkins Jul 2017</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-5dfd312158be62795ec01e8ec19fcc3f82204ab4009f7e401ea7649a986531fd3</citedby><cites>FETCH-LOGICAL-c383t-5dfd312158be62795ec01e8ec19fcc3f82204ab4009f7e401ea7649a986531fd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/26418392$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/26418392$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28614178$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garg, Renu K.</creatorcontrib><creatorcontrib>Fulton-Kehoe, Deborah</creatorcontrib><creatorcontrib>Franklin, Gary M.</creatorcontrib><title>Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients</title><title>Medical care</title><addtitle>Med Care</addtitle><description>The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk.
To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users.
This is a retrospective cohort study.
In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid.
Average daily dose (morphine equivalents), opioid schedule/duration of action, sedative-hypnotic use.
Compared with patients at 1-19 mg/d, risk of opioid overdose death significantly increased at 50-89 mg/d [adjusted hazard ratio (aHR), 2.3; 95% confidence interval (CI), 1.4-4.1], 90-119 mg/d (aHR, 4.0; 95% CI, 2.2-7.3), 120-199 mg/d (aHR, 3.8; 95% CI, 2.1-6.9), and ≥200 mg/d (aHR, 4.9; 95% CI, 2.9-8.1). Patients using long-acting plus short-acting Schedule II opioids had 4.7 times the risk of opioid overdose death than non-Schedule II opioids alone (aHR, 4.7; 95% CI, 3.3-6.9). Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death (aHR, 6.4; 95% CI, 5.0-8.4). Risk was particularly high for opioids combined with benzodiazepines and skeletal muscle relaxants (aHR, 12.6; 95% CI, 8.9-17.9). Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics (aHR, 5.6; 95% CI, 1.6-19.3).
Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - poisoning</subject><subject>Benzodiazepines</subject><subject>Chronic Pain - drug therapy</subject><subject>Confidence intervals</subject><subject>Death</subject><subject>Disease control</subject><subject>Drug overdose</subject><subject>Drug Overdose - mortality</subject><subject>Female</subject><subject>Government programs</subject><subject>Health care</subject><subject>Humans</subject><subject>Hypnotics</subject><subject>Male</subject><subject>Medicaid</subject><subject>Middle Aged</subject><subject>Morphine</subject><subject>Mortality</subject><subject>Muscle relaxants</subject><subject>Musculoskeletal system</subject><subject>Narcotics</subject><subject>Opioid receptors (type delta)</subject><subject>Original Article</subject><subject>Overdose</subject><subject>Pain</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Skeletal muscle</subject><subject>Thresholds</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0025-7079</issn><issn>1537-1948</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkN1LwzAUxYMobn78ByoFX3zpzE3SJnkc8xM2NoZ7Lll7q51bM5NW8L83sqlj9-XCPb9zuBxCLoD2gGp5OxpOe3R3JFcHpAsJlzFooQ5Jl1KWxJJK3SEn3i8oBckTdkw6TKUgQKoumUxM06CrfWTLaLyubFVEM4-RqYtoWvn3nfP4E11hg3aHpnmL-itbv0YjLKrcBDXkVFg3_owclWbp8Xy7T8ns4f5l8BQPx4_Pg_4wzrniTZwUZcGBQaLmmDKpE8wpoMIcdJnnvFSMUWHmglJdShRBMzIV2miVJhyC95TcbHLXzn606JtsVfkcl0tTo219Bhoo5ylwEdDrPXRhW1eH7wLFNOVaSxYosaFyZ713WGZrV62M-8qAZj-NZ6HxbL_xYLvahrfzFRZ_pt-KA3C5ARa-se5fTwUorhn_BiOdguE</recordid><startdate>20170701</startdate><enddate>20170701</enddate><creator>Garg, Renu K.</creator><creator>Fulton-Kehoe, Deborah</creator><creator>Franklin, Gary M.</creator><general>Wolters Kluwer Health, Inc</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20170701</creationdate><title>Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients</title><author>Garg, Renu K. ; Fulton-Kehoe, Deborah ; Franklin, Gary M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-5dfd312158be62795ec01e8ec19fcc3f82204ab4009f7e401ea7649a986531fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - poisoning</topic><topic>Benzodiazepines</topic><topic>Chronic Pain - drug therapy</topic><topic>Confidence intervals</topic><topic>Death</topic><topic>Disease control</topic><topic>Drug overdose</topic><topic>Drug Overdose - mortality</topic><topic>Female</topic><topic>Government programs</topic><topic>Health care</topic><topic>Humans</topic><topic>Hypnotics</topic><topic>Male</topic><topic>Medicaid</topic><topic>Middle Aged</topic><topic>Morphine</topic><topic>Mortality</topic><topic>Muscle relaxants</topic><topic>Musculoskeletal system</topic><topic>Narcotics</topic><topic>Opioid receptors (type delta)</topic><topic>Original Article</topic><topic>Overdose</topic><topic>Pain</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Skeletal muscle</topic><topic>Thresholds</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garg, Renu K.</creatorcontrib><creatorcontrib>Fulton-Kehoe, Deborah</creatorcontrib><creatorcontrib>Franklin, Gary M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Medical care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garg, Renu K.</au><au>Fulton-Kehoe, Deborah</au><au>Franklin, Gary M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients</atitle><jtitle>Medical care</jtitle><addtitle>Med Care</addtitle><date>2017-07-01</date><risdate>2017</risdate><volume>55</volume><issue>7</issue><spage>661</spage><epage>668</epage><pages>661-668</pages><issn>0025-7079</issn><eissn>1537-1948</eissn><abstract>The Centers for Disease Control and Prevention recognizes Medicaid as a high-risk population for fatal opioid overdose. Further research is needed to identify factors that put Medicaid patients at increased risk.
To determine whether patterns of opioid use are associated with risk of opioid-related mortality among opioid users.
This is a retrospective cohort study.
In total, 150,821 noncancer pain patients aged 18-64 years with ≥1 opioid prescription, April 2006 to December 2010, Washington Medicaid.
Average daily dose (morphine equivalents), opioid schedule/duration of action, sedative-hypnotic use.
Compared with patients at 1-19 mg/d, risk of opioid overdose death significantly increased at 50-89 mg/d [adjusted hazard ratio (aHR), 2.3; 95% confidence interval (CI), 1.4-4.1], 90-119 mg/d (aHR, 4.0; 95% CI, 2.2-7.3), 120-199 mg/d (aHR, 3.8; 95% CI, 2.1-6.9), and ≥200 mg/d (aHR, 4.9; 95% CI, 2.9-8.1). Patients using long-acting plus short-acting Schedule II opioids had 4.7 times the risk of opioid overdose death than non-Schedule II opioids alone (aHR, 4.7; 95% CI, 3.3-6.9). Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death (aHR, 6.4; 95% CI, 5.0-8.4). Risk was particularly high for opioids combined with benzodiazepines and skeletal muscle relaxants (aHR, 12.6; 95% CI, 8.9-17.9). Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics (aHR, 5.6; 95% CI, 1.6-19.3).
Our findings support Federal guideline-recommended dosing thresholds in opioid prescribing. Concurrent sedative-hypnotic use even at low opioid doses poses substantially greater risk of opioid overdose.</abstract><cop>United States</cop><pub>Wolters Kluwer Health, Inc</pub><pmid>28614178</pmid><doi>10.1097/MLR.0000000000000738</doi><tpages>8</tpages></addata></record> |
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| ispartof | Medical care, 2017-07, Vol.55 (7), p.661-668 |
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| subjects | Adolescent Adult Analgesics, Opioid - administration & dosage Analgesics, Opioid - poisoning Benzodiazepines Chronic Pain - drug therapy Confidence intervals Death Disease control Drug overdose Drug Overdose - mortality Female Government programs Health care Humans Hypnotics Male Medicaid Middle Aged Morphine Mortality Muscle relaxants Musculoskeletal system Narcotics Opioid receptors (type delta) Original Article Overdose Pain Patients Retrospective Studies Risk Assessment Skeletal muscle Thresholds United States - epidemiology Young Adult |
| title | Patterns of Opioid Use and Risk of Opioid Overdose Death Among Medicaid Patients |
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