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. 2020 Feb;58(2):250-253.
doi: 10.1016/j.amepre.2019.09.022.

Opioid Prescribing Patterns Before Fatal Opioid Overdose

Ali B Abbasi  1 , Elizabeth Salisbury-Afshar  2 , Craig E Berberet  3 , Jennifer E Layden  4 , Mai T Pho  5
Affiliations

Opioid Prescribing Patterns Before Fatal Opioid Overdose

Ali B Abbasi et al. Am J Prev Med. 2020 Feb.

Abstract

Introduction: Although opioid prescribing has decreased since 2010, overdose deaths involving illicit opioids have continued to rise. This study explores prescribing patterns before fatal overdose of decedents who died of prescription and illicit opioid overdoses.

Methods: This retrospective cohort study was conducted in 2019 and included all 1,893 Illinois residents who died of an opioid-related overdose in 2016. Each decedent was linked to any existing Prescription Monitoring Program records, calculating weekly morphine milligram equivalents for 52 weeks before overdose.

Results: Among the 1,893 fatal opioid overdoses, 309 involved any prescription opioid and 1,461 involved illicit opioids without the involvement of prescription opioids. The death rate because of illicit opioids was 23/100,000 among black residents versus 10.5/100,000 among whites. During the last year of life, 76% of prescription opioid decedents filled any opioid prescription totaling 10.7 prescriptions per decedent, compared with 36% of illicit opioid decedents totaling 2.6 prescriptions per decedent. During the last week of life, 33% of prescription opioid decedents filled an opioid prescription totaling 0.42 prescriptions per decedent, compared with 4% of illicit opioid decedents totaling 0.05 prescriptions per decedent.

Conclusions: Prescribing patterns alone may not be sufficient to identify patients who are at high risk for opioid overdose, especially for those using illicit opioids. Interventions aimed at reducing opioid overdoses should take into account different patterns of opioid prescribing associated with illicit and prescription opioid overdose deaths and be designed around the local characteristics of the opioid overdose epidemic.

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Figures

Figure 1.
Figure 1.
Daily morphine milligram equivalent (MME) of decedents stratified by whether overdose involved prescription opioids for one year prior to fatal overdose. Notes: Daily MME is the sum of all active prescriptions based on the start date, days’ supply, and MME. Decedents in prescription group died of overdoses involving any prescription opioids with or without the additional involvement of illicit opioids. Decedents in illicit group died of overdose involving heroin, fentanyl, or fentanyl analogues without the involvement of prescription opioids. OD, overdose.
See this image and copyright information in PMC

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