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Study Identifies Risk Factors for Opioid Overdose After First Opioid Prescription
Older age, male sex, and having Medicaid or Medicare Advantage coverage are among patient risk factors for experiencing an opioid overdose after an initial opioid prescription, according to a study published in JAMA Network Open.
“In the present cohort, those who were at the highest adjusted risk for subsequent overdose were older (≥75 years) and younger (18-24 years) individuals,” wrote lead author Scott G. Weiner, MD, MPH, of Brigham and Women’s Hospital, Boston, Massachusetts, and coauthors. “The fact that older patients had a hazard ratio of 3.22 compared with the reference group (aged 35-44 years) is concerning because opioid prescribing to older patients occurs frequently, and recent data have shown an increase of opioid-related hospitalizations among older patients.”
The study focused on a population-based sample of 236,921 adults in Oregon who received a first opioid prescription in 2015 and were followed through 2018. Among them, 667 patients (0.3%) experienced a subsequent opioid overdose.
Besides older age and male sex, publicly insured patients had greater overdose risk.
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“Patients with Medicaid had an almost 4-fold increased risk of overdose compared with the commercially insured population,” researchers wrote, “whereas those who were dually eligible for Medicaid and Medicare Advantage had an even higher risk.”
Additional patient-related factors associated with increased opioid overdose risk were comorbid substance use disorder (researchers reported a 2.74 adjusted hazard ratio), depression (a 1.26 adjusted hazard ratio), and medical comorbidities (having 3 or more comorbidities was linked with a 1.90 adjusted hazard ratio).
The study also looked at prescription-related risk factors. Findings showed an initial prescription for oxycodone or tramadol, concurrent benzodiazepine use, and filling opioid prescriptions at 3 or more pharmacies over 6 months were associated with opioid overdose.
“These risk factors may be considered by prescribers to identify opioid-naive patients who may be most at risk for harm; to inform patient counseling and monitoring if opioids are prescribed; and to provide additional information on safe use, storage, and disposal of opioids and on signs of overdose,” researchers advised.
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