Opioid Prescribing After Nonfatal Overdose and Association With Repeated Overdose: A Cohort Study.

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.

Duke Scholars

Author J. Franklin Wharam Medicine, General Internal Medicine