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Patients’ overdoses do little to curb their opioid use
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Prescription opioid use remained high among Medicaid patients who received medical attention for an overdose, according to a research letter recently published in JAMA.
“Little is known about how opioid prescribing and medication-assisted treatment changes from before to after overdose among Medicaid enrollees, who have a [three times] higher risk of opioid overdose,” Winfred Frazier, MD, MPH, of the department of public policy and management at the University of Pittsburgh Graduate School of Public Health and colleagues wrote.
To gather more data, researchers performed a retrospective cohort analysis of 6,013 Medicaid enrollees aged 12 to 64 years in Pennsylvania. Of these patients, 3,945 had a prescription opioid overdose and 2,068 had a heroin overdose. All were enrolled 6 months before and after their overdose claim.
Frazier and colleagues found that the number of patients filling an opioid prescription decreased from 43.2% to 39.7% after heroin overdose (P = .005), and from 66.1% before to 59.6% after prescription opioid overdose (P < .001).
In addition, the percentage of enrollees with 90 days or more duration of prescription opioids decreased in the heroin group from 10.5% to 9% (P = .01) and from 32.5% to 28.3% in the prescription opioid group (P < .001). In addition, medication assistance therapy increased after heroin overdose from 29.5% to 33% (P = .002) and after prescription opioid overdose from 13.5% to 15.1% (P = .001).
“Among people treated in hospitals for an overdose (either heroin- or prescription opioid-related), there was relatively little change in either the likelihood that they went on to fill opioid prescriptions in the future, or the likelihood that they were prescribed medications for treating opioid addiction,” Julie M. Donohue, PhD, department of public policy and management at the University of Pittsburgh Graduate School of Public Health, told Healio Family Medicine in an interview. “That amounts to a missed opportunity to prevent a future, possibly fatal overdose.”
She provided a suggestion for how primary care physicians can use the study’s findings to help their patients.
“In addition to relying on data available in prescription drug monitoring databases, physicians should screen for a history of addiction before prescribing opioids.”
Researchers added that interventions that alert medical professionals to patients treated for overdose, as well as ED–initiated naloxone education and distribution, have been proven to reduce overdose risk.
There are an estimated 30 nonfatal opioid overdoses for every fatal one, according to researchers. – by Janel Miller
Disclosure: The researchers report no relevant financial disclosures.
Editor's note: This story has been updated from an earlier version to include quotes from Julie M. Donohue.