Study Shows Higher Opioid Doses Associated with Increased Risk of Overdose

April 7, 2011

Researchers also found that more than half of patients prescribed opioids had filled another opioid prescription within the previous 30 days.

Researchers also found that more than half of patients prescribed opioids had filled another opioid prescription within the previous 30 days.

A study conducted by researchers from the Department of Veterans Affairs, Health Services Research & Development Centers of Excellence in Philadelphia and Indianapolis has found that larger daily prescribed doses of opioids are associated with an increased risk of overdose death.

The study, published in JAMA, examined “the association of maximum prescribed daily opioid dose and dosing schedule… with risk of opioid overdose death among patients with cancer, chronic pain, acute pain, and substance use disorders” among a cohort of more than 150,000 patients who received medical services from the Veterans Medical Association and received opioid therapy for pain.

The researchers found that the “risk of overdose death was directly related to the maximum prescribed daily dose of opioid medication,” and estimated the frequency of fatal overdose among individuals in this study treated with opioids to be 0.04%.

Although they found that receiving “both as-needed and regularly scheduled doses was not associated with overdose risk,” they concluded that “higher opioid doses were associated with increased risk of opioid overdose death” among patients being treated for pain with opioid medications.

National Institute on Drug Abuse (NIDA) Director Nora D. Volkow, MD, and Thomas McLellan, PhD, of the Center for Substance Abuse Solutions, University of Pennsylvania School of Medicine, wrote a commentary in JAMA on this study and the challenges of effective opioid prescribing, titled “Curtailing Diversion and Abuse of Opioid Analgesics without Jeopardizing Pain Treatment.”

A news release from NIDA noted that the number of prescriptions written for opioid medications increased 300% from 1991-2009 (with more than 200 million opioid prescriptions written in 2009), during which time frame the number of emergency room visits related to the nonmedical use of pharmaceutical opioids doubled.

According to NIDA, the JAMA study also found that more than half of patients who receive prescriptions for opioids have filled another prescription for opioids from the same or different providers within the previous 30 days.

The study revealed that that more than half (56%) of painkiller prescriptions “were given to patients who had filled another prescription for pain from the same or different providers within the past month.” The researchers also reported that 12% of opioid prescriptions were written for adolescents and young adults between the ages of 10 and 29; most of these prescriptions were “hydrocodone- and oxycodone-containing products, like Vicodin and Oxycontin.” Nearly half (46%) of opioid prescriptions were written for patients between the ages of 40 and 59. The study revealed that dentists were “the main prescribers for youth aged 10-19 years old,” while most of the opioid prescriptions for older adults were from primary care providers.

Volkow said that these findings, added to previous study results revealing the dangers of opioid abuse, misuse, and diversion, show that “more research is needed to see if current practices are working, with a closer look at why so many patients are getting multiple prescriptions within a short period of time… As a nation, it is important that we all become better informed about effective pain management and the risks of abusing prescription painkillers.”