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91% who overdose on opioids continue to

receive opioid prescriptions

BY MARY ANN MOON

Frontline Medical News

From Annals of Internal Medicine

A

lmost all patients who had nonfatal over-

doses while taking long-term opioids for

noncancer pain continued to receive opi-

oid prescriptions, usually from the same physi-

cians, in a nationwide cohort study published

online Dec. 28 in

Annals of Internal Medicine.

Clinical guidelines specify that adverse

events related to the misuse of opioids are

clear indications to discontinue long-term

opioid therapy. But patterns of prescribing

after opioid overdoses are not monitored. To

examine prescribing trends following nonfatal

opioid overdoses, researchers analysed infor-

mation in a database of inpatient, outpatient,

and pharmacy claims from a large US health

insurer covering all 50 states.

They focused on 2848 insured adults en-

rolled in 2000–2012 who received hospital

or ED treatment for a prescription opioid

overdose and were followed in the database

for a median of 15 months. The prescribed

drugs included codeine, dihydrocodeine, me-

peridine, morphine, oxycodone, hydrocodone,

hydromorphone, fentanyl, oxymorphone,

propoxyphene, methadone, tramadol, and

levorphanol, said Dr Marc R. Larochelle of

Boston Medical Centre and his associates.

A total of 2597 of these patients (91%)

continued to receive opioid prescriptions after

their overdose. The primary prescriber was the

same person before and after the overdose

in 1198 cases (61%). Two hundred twelve of

these patients (7%) had another opioid over-

dose during follow-up. The likelihood of a

second overdose was much higher for patients

taking the highest doses of opioids (100 mg

or more morphine-equivalent dosage per day),

with hazard ratios of 1.13 for patients taking

low doses of opioids, 1.89 for those taking

mid-range doses, and 2.57 for those taking

high doses.

“We could not determine the reason for the

treatment patterns after the overdose; how-

ever, some prescribers may have been una-

ware that the opioid overdose had occurred”

because there are no procedures in place to

ensure provider notification in such cases.

Newly introduced prescription monitoring

programs may facilitate such communication,

but a more rigorous approach would mandate

that all overdoses be reported to public health

departments, which would then notify pro-

viders and pharmacies, and perhaps secure

patient referral to substance abuse treatment

programs, the investigators said (

Ann Intern

Med

2015 Dec 28. doi: 10.7326/M15-0038).

It is possible that some overdoses stemmed

from therapeutic error rather than opioid mis-

use, and that providers felt the risk-benefit

ratio justified continued opioid treatment. But

it also is likely that many providers simply did

not have the knowledge and skills to identify

and treat opioid misuse, they added.

“Simply eliminating opioid prescribing for

patients who had an overdose is not suffi-

cient. … because some [patients] may turn

to diverted or illicit opioids. Rather, efforts to

identify and treat substance use disorders in

these patients are needed,” Dr Larochelle and

his associates said.

Overall, the study findings indicate that

nonfatal overdoses provide a meaningful op-

portunity to improve the safety of opioid pre-

scribing, but that most prescribers at present

are missing this opportunity.

Rheumatology Conference 2016

MARCH

4–8 March | San Francisco, USA

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meetings/2016-annual-meeting

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The Netherlands

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International (OARSI): World

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New resource centre offers best

available evidence on Zika virus

In view of the global concern

over the outbreak of the Zika

virus, both Elsevier and

The

Lancet

have created a Zika

Virus Resource Center on

Elsevier Connect with the

latest updates, research,

reviews, editorials, corre-

spondence and commentary

to help healthcare profession-

als, medical researchers and

the public understand the

outbreak.

Both info centres are advised

by clinicians and professional

editors, and will be updated

with the most current research

and evidence-based informa-

tion available.

“With our virus resource centre on

The Lancet

, and with one on Elsevier Connect,

we strive to bring together the best available evidence on Zika to assist researchers,

policy makers and health workers in understanding the effects of the outbreak and

how best to respond,” said Richard Horton, Editor-in-Chief of

The Lancet.

“Decisions

affecting the public’s health should be supported by the best available evidence,

and our resource centre will aim to keep policy makers and others updated with

the latest research and analysis as developments unfold.”

Both resource centres can be accessed through

elsevier.com/connect/zika-virus-resource-center

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