Prescription Drug Overdose Death Research Articles

Using the CA Opioid Overdose Surveillance Dashboard to track opioid overdose deaths

Using the CA Opioid Overdose Surveillance Dashboard to track opioid overdose deaths

Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death

Background: This study evaluates complete state data from controlled substance prescribing trends in the prescription monitoring program (PMP) database and their association with the risk of prescription drug overdose death. Summary: Maine PMP records of individuals who died of prescription overdose deaths between 2006 and 2010 were selected (n = 690). For each subject, an age, gender, and residence matched cohort of PMP users in a 50: 1 ratio was identified (n = 34,500). Key Messages: Prescription opioids contributed to 480 of 690 prescription deaths, many co-ingestions were noted, and OR for overdose death increased with milligram of morphine equivalent (MME)/day >100. The majority who were prescribed MME >100 per day received a prescription within 90 days of overdose matching the toxicology cause of death. Conclusions: Medication profiles available through state PMP can identify dosing of prescriptions associated with drug overdose death.

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Lidocaine Infusion: A Promising Therapeutic Approach for Chronic Pain.

Opioid abuse is a national epidemic in the United States, where it is estimated that a prescription drug overdose death occurs every 19 minutes. While opioids are highly effective in acute and subacute pain control, their use for treatment of chronic pain is controversial. Chronic opioids use is associated with tolerance, dependency, hyperalgesia. Although there are new strategies and practice guidelines to reduce opioid dependence and opioid prescription drug overdose, there has been little focus on development of opioid-sparing therapeutic approaches. Lidocaine infusion has been shown to be successful in controlling pain where other agents have failed. The opioid sparing properties of lidocaine infusion added to its analgesic and antihyperalgesic properties make lidocaine infusion a viable option for pain control in opioid dependent patients. In this review, we provide an overview of the opioid abuse epidemic, and we outline current evidence supporting the potential use of lidocaine infusion as an adjuvant therapeutic approach for management of chronic pain.

Opioid Safety: We Are Not There Yet

Opioids are highly effective in acute pain control; however, their use for the treatment of chronic non-cancer pain is controversial. Chronic opioid use is associated with several side effects that include and are not limited to tolerance, dependence, and hyperalgesia. Opioid prescription drug overdose is at a national epidemic status in the USA. It is estimated that a prescription drug overdose death occurs every 19 min. Several national and state interventions have been implemented to address the staggering statistics of increased deaths due to opioid overdose. The recently released Center of Disease Control (CDC) practice guidelines are designed to improve physician patient communication and avoid opioid prescription drug overdose. In this chapter, we will review some of the recent guidelines for opioid prescribing and the current efforts in place to address this epidemic.

Emergency department utilization and subsequent prescription drug overdose death

PurposePrescription drug overdose (PDO) deaths are a critical public health problem in the United States. This study aims to assess the association between emergency department (ED) utilization patterns in a cohort of ED patients and the risk of subsequent unintentional PDO mortality. MethodsUsing data from the New York Statewide Planning and Research Cooperative System for 2006–2010, a nested case-control design was used to examine the relationship between ED utilization patterns in New York State residents of age 18–64 years and subsequent PDO death. ResultsThe study sample consisted of 2732 case patients who died of PDO and 2732 control ED patients who were selected through incidence density sampling. With adjustment for demographic characteristics, and diagnoses of pain, substance abuse, and psychiatric disorders, the estimated odds ratios of PDO death relative to one ED visit or less in the previous year were 4.90 (95% confidence interval [CI]: 4.50–5.34) for those with two ED visits, 16.61 (95% CI: 14.72–18.75) for those with three ED visits, and 48.24 (95% CI: 43.23–53.83) for those with four ED visits or more. ConclusionsFrequency of ED visits is strongly associated with the risk of subsequent PDO death. Intervention programs targeting frequent ED users are warranted to reduce PDO mortality.

The Development of the Washington State Emergency Department Opioid Prescribing Guidelines

The Centers for Disease Control and Prevention (CDC) has classified prescription drug abuse as an epidemic due to the recent dramatic increase in prescription drug overdose deaths. In addition to an increase in overdose deaths involving opioid analgesics, there has also been an increase in substance abuse treatment admissions and an increase in emergency department (ED) visits for nonmedical use of opioid analgesics [1]. According to the Drug Abuse Warning Network, the estimated number of ED visits for nonmedical use of opioid analgesics more than doubled from 2004 to 2008 (from 144,600 to 305,900 visits) [2]. Although quantifying the amount of opioids prescribed from an ED in comparison to other specialties has been a challenge, data from the 2003–2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey suggest that the ED accounts for 39 % of opioid administration or medical record prescription mentions compared with 30.5 % for primary care offices [3]; however, this source does not likely account for the small total amount prescribed from the ED. Analyses of the Vector One National database suggest that ED physicians are among the top five outpatient specialties prescribing opioids to patients 39 years old and younger along with primary care physicians, dentists, and pediatricians [4]. Among individuals who abused prescription opioids upon entering methadone treatment, 13 % reported obtaining their opioids from EDs; [5] Washington State Department of Health (WSDOH) had been concerned regarding data suggesting higher rates of drug overdose deaths and a higher percentage of nonmedical use of prescription pain medication in Washington State compared to the rest of the nation [6]. In 2010, opioid analgesic prescribing per capita in Washington State was significantly higher than the national average—ranking ninth in the nation. In addition, Washington State ranked 14th in the nation in drug overdose deaths in 2008 [1].

Mental Illness and Psychotropic Drug Use Among Prescription Drug Overdose Deaths

Between 1999 and 2006, there was a 120% increase in the rate of unintentional drug overdose deaths in the United States. This study identifies the prevalence of mental illness, a risk factor for substance abuse, and chronic pain among prescription drug overdose deaths in West Virginia and ascertains whether psychotropic drugs contributing to the deaths were used to treat mental illness or for nonmedical purposes. In 2007, we abstracted data on mental illness, pain, and drugs contributing to death from all unintentional prescription drug overdose deaths in 2006 recorded by the West Virginia Office of the Chief Medical Examiner. Decedent prescription records were obtained from the state prescription drug monitoring program. Histories of mental illness and pain were documented in 42.7% and 56.6% of 295 decedents, respectively. Psychotropic drugs contributed to 48.8% of the deaths, with benzodiazepines involved in 36.6%. Benzodiazepines contributing to death were not associated with mental illness (adjusted odds ratio [AOR] = 1.1; 95% CI, 0.6-1.8), while all other psychotropic drugs were (AOR = 3.9; 95% CI, 2.0-7.6). Of decedents with contributory benzodiazepines, 46.3% had no prescription for the drug. Mental illness may have contributed to substance abuse associated with deaths. Clinicians should screen for mental illness when prescribing opioids and recommend psychotherapy as an adjunct or an alternate to pharmacotherapy. Benzodiazepines may have been used nonmedically rather than as a psychotropic drug, reflecting drug diversion. Restricting benzodiazepine prescriptions to a 30-day supply with no refills might be considered.

Unintentional Prescription Drug Overdose Deaths in New Mexico, 1994–2003

New Mexico has the highest rate of drug-induced mortality in the United States. The contribution of prescription drugs to the total overdose death rate has not been adequately described. A total of 1,906 unintentional drug overdose deaths occurring in 1994 to 2003 in New Mexico were analyzed. Unintentional drug overdose death was defined as death caused by prescription, illicit, or a combination of drugs, as determined by a pathologist. Deaths were investigated annually by the medical examiner and data were analyzed in 2004-2005. Rates and trends of total and prescription drug overdose death were calculated, decedent characteristics were analyzed, and common drug combinations causing death were described. The rate of unintentional prescription drug overdose death increased by 179% (1.9 to 5.3/100,000) from 1994 to 2003. A high percentage of prescription drug overdose decedents were white non-Hispanic (63.2%) and female (43.9%). These decedents were older and less frequently had alcohol listed as an additional cause of death than decedents of other drug overdose categories. Of all deaths caused by prescription drug(s) (n =765), 590 (77.1%) were caused by opioid painkillers, 263 (34.4%) by tranquilizers, and 196 (25.6%) by antidepressants. The rate of prescription drug overdose death in New Mexico increased significantly over the 10-year study period. Comprehensive surveillance of drug overdose deaths is recommended to describe their occurrence in the context of both medical and diverted use of prescription drugs. Understanding decedent profiles and the potential risk factors for prescription drug overdose death is crucial for effective drug overdose prevention education among healthcare providers.