High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths | Clinical Pharmacy and Pharmacology | JAMA Internal Medicine | JAMA Network
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    1 Comment for this article
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    High dose opioid treatment
    Louis Ogden | Chronic & centralized pain patient
    I have suffered agonizing pain beginning in childhood and up until I was in my early 60s and for almost 4 years I've been on an ultra-high dose opioid therapy (note: I have a defective gene that keeps me from metabolizing well). Simply stated, I have had my highest quality of life since I started this treatment. I will NEVER be able to understand why this is so controversial nor why the debate ALWAYS centers on abuse. IMO, these drugs are safe when used as directed as they do not damage organs, etc. yet I am constantly scrutinized, been called a drug addict to my face by health professionals & others, and many more indignities. This treatment has saved my life as I was thinking suicide after 50+ years of suffering yet it is as if I am GUILTY of something and must prove my innocence - contrary to our Constitution. I do not misuse nor do I sell my medicines but it is a constant fight!
    CONFLICT OF INTEREST: None Reported
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    Original Investigation
    May 2014

    High-Risk Use by Patients Prescribed Opioids for Pain and Its Role in Overdose Deaths

    Author Affiliations
    • 1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Tennessee Department of Health, Nashville
    • 2currently with Agency for Healthcare Research and Quality, Rockville, Maryland
    • 3Tennessee Department of Health, Nashville
    • 4 Department of Preventive Medicine and Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
    • 5Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Atlanta, Georgia
    JAMA Intern Med. 2014;174(5):796-801. doi:10.1001/jamainternmed.2013.12711
    Abstract

    Importance  From January 1, 2003, through December 31, 2010, drug overdose deaths in Tennessee increased from 422 to 1059 per year. More of these deaths involved prescription opioids than heroin and cocaine combined.

    Objective  To assess the contribution of certain opioid-prescribing patterns to the risk of overdose death.

    Design, Setting, and Participants  We performed a matched case-control study that analyzed opioid prescription data from the Tennessee Controlled Substances Monitoring Program (TNCSMP) from January 1, 2007, through December 31, 2011, to identify risk factors associated with opioid-related overdose deaths from January 1, 2009, through December 31, 2010. Case patients were ascertained from death certificate data. Age- and sex-matched controls were randomly selected from among live patients in the TNCSMP.

    Main Outcomes and Measures  We defined a high-risk number of prescribers or pharmacies as 4 or more per year and high-risk dosage as a daily mean of more than 100 morphine milligram equivalents (MMEs) per year. The main outcome was opioid-related overdose death.

    Results  From January 1, 2007, through December 31, 2011, one-third of the population of Tennessee filled an opioid prescription each year, and opioid prescription rates increased from 108.3 to 142.5 per 100 population per year. Among all patients in Tennessee prescribed opioids during 2011, 7.6% used more than 4 prescribers, 2.5% used more than 4 pharmacies, and 2.8% had a mean daily dosage greater than 100 MMEs. Increased risk of opioid-related overdose death was associated with 4 or more prescribers (adjusted odds ratio [aOR], 6.5; 95% CI, 5.1-8.5), 4 or more pharmacies (aOR, 6.0; 95% CI, 4.4-8.3), and more than 100 MMEs (aOR, 11.2; 95% CI, 8.3-15.1). Persons with 1 or more risk factor accounted for 55% of all overdose deaths.

    Conclusions and Relevance  High-risk use of prescription opioids is frequent and increasing in Tennessee and is associated with increased overdose mortality. Use of prescription drug–monitoring program data to direct risk-reduction measures to the types of patients overrepresented among overdose deaths might reduce mortality associated with opioid abuse.

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