Higher opioid overdose death risk with higher doses

Among patients receiving prescriptions for opioid analgesics for pain, higher doses are associated with an increased risk of overdose death. However, the increased risk of opioid overdose is not statistically significant in patients who are treated with as-needed and regularly scheduled opioids simultaneously.

Bohnert and colleagues conducted a case-cohort study to examine the relationship between opioid prescribing patterns and risk of opioid-related deaths in a national sample of Veterans Health Administration patients. Opioid overdose death was determined using National Death Index files. Morphine-equivalent doses for opioid analgesic medications were calculated using established methods.

The rate of fatal overdose over the study period among patients treated with opioids was estimated to be 0.04%. Opioid overdose decedents were statistically significantly more likely to be middle-aged and white; more likely to have chronic or acute pain, substance use disorders, and other psychiatric diagnoses; and less likely to have cancer. The overdose rate was higher at higher maximum daily doses compared with lower maximum daily doses across all subgroups examined.

The authors noted that the risk of opioid overdose should continue to be evaluated relative to the need to reduce pain and suffering and should be considered along with other risk factors.